Healthcare Provider Details

I. General information

NPI: 1922485002
Provider Name (Legal Business Name): PAMELA CUMMINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 HARBOUR PARK DR
MIDLOTHIAN VA
23112-2163
US

IV. Provider business mailing address

215 SHUMAN BLVD 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 804-639-9008
  • Fax: 804-639-7739
Mailing address:
  • Phone: 630-303-5380
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101001299
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number03-0000250
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: