Healthcare Provider Details

I. General information

NPI: 1871787903
Provider Name (Legal Business Name): PAMELA SMILEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2007
Last Update Date: 08/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

07 CHOOSGHI DRIVE
TOHATCHI NM
87325
US

IV. Provider business mailing address

PO BOX 142
TOHATCHI NM
87325-0142
US

V. Phone/Fax

Practice location:
  • Phone: 505-733-8100
  • Fax: 505-733-8239
Mailing address:
  • Phone: 505-733-8100
  • Fax: 505-733-8239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR40886
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: