Healthcare Provider Details

I. General information

NPI: 1003729013
Provider Name (Legal Business Name): PAMELA ANN STAFFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 23RD ST
COLUMBUS NE
68601-3427
US

IV. Provider business mailing address

1612 7TH ST
COLUMBUS NE
68601-6912
US

V. Phone/Fax

Practice location:
  • Phone: 402-695-9831
  • Fax: 617-340-3371
Mailing address:
  • Phone: 402-942-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: