Healthcare Provider Details

I. General information

NPI: 1619958287
Provider Name (Legal Business Name): PAMELA BEAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 TENTH STREET HODGE 3
N. TONAWANDA NY
14302
US

IV. Provider business mailing address

908 NIAGARA FALLS BLVD STE. 208
N TONAWANDA NY
14120-2019
US

V. Phone/Fax

Practice location:
  • Phone: 716-692-3302
  • Fax:
Mailing address:
  • Phone: 716-692-3302
  • Fax: 716-692-4342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number002140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: