Healthcare Provider Details

I. General information

NPI: 1841655669
Provider Name (Legal Business Name): PAMELA ANN NULL CRNP, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 01/19/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 MAPLE AVENUE
DUBOIS PA
15801-2376
US

IV. Provider business mailing address

621 S MAIN ST
DU BOIS PA
15801-1413
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-6379
  • Fax: 814-375-9320
Mailing address:
  • Phone: 814-299-7520
  • Fax: 814-375-7798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015397
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP029112
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: