Healthcare Provider Details

I. General information

NPI: 1184961740
Provider Name (Legal Business Name): PAMELA SUE WORDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2013
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5372 MIRAGE CIR
DIMONDALE MI
48821-9303
US

IV. Provider business mailing address

5372 MIRAGE CIR
DIMONDALE MI
48821-9303
US

V. Phone/Fax

Practice location:
  • Phone: 517-388-2087
  • Fax:
Mailing address:
  • Phone: 517-388-2087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number4704202017
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: