Healthcare Provider Details

I. General information

NPI: 1003956087
Provider Name (Legal Business Name): PAMELA S MCKINNEY CRNFA, CNOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARES SURGERY CENTER
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

189 BROOKFIELD DR
JACKSON NJ
08527-3869
US

V. Phone/Fax

Practice location:
  • Phone: 732-252-8514
  • Fax:
Mailing address:
  • Phone: 732-252-8514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number92832
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: