Healthcare Provider Details

I. General information

NPI: 1467817593
Provider Name (Legal Business Name): PAMELA MCFADDEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA KOLESAR

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

IV. Provider business mailing address

460 W 10TH AVE
COLUMBUS OH
43210-1240
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8333
  • Fax:
Mailing address:
  • Phone: 614-293-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN334886-1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 18462 NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: