Healthcare Provider Details

I. General information

NPI: 1518458223
Provider Name (Legal Business Name): PAMELA D OQUENDO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CATALINA AVE
YOUNGSTOWN OH
44504-1466
US

IV. Provider business mailing address

455 CATALINA AVE
YOUNGSTOWN OH
44504-1466
US

V. Phone/Fax

Practice location:
  • Phone: 440-319-1618
  • Fax:
Mailing address:
  • Phone: 440-319-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN273784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: