Healthcare Provider Details

I. General information

NPI: 1386096824
Provider Name (Legal Business Name): PAMELA ANN SKOCIC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 EASTLAND RD
BEREA OH
44017-1217
US

IV. Provider business mailing address

434 EASTLAND RD
BEREA OH
44017-1217
US

V. Phone/Fax

Practice location:
  • Phone: 440-260-8327
  • Fax: 440-260-8305
Mailing address:
  • Phone: 440-260-8327
  • Fax: 440-260-8305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.400409
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: