Healthcare Provider Details

I. General information

NPI: 1619600202
Provider Name (Legal Business Name): PAMELA MARIE HASTINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E GREEN ST
ITHACA NY
14850-5635
US

IV. Provider business mailing address

201 E GREEN ST
ITHACA NY
14850-5635
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number750781
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: