MEDICARE: PAMELA SUE ANGLIN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	644811-1	NY

General Provider Information

NPI Number	:	1104178698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA SUE ANGLIN RN

Provider Business Mailing Address
First Line	:	56 FORT BROWN DR
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-4935
Country	:	US
Telephone Number	:	413-531-6752
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 FORT BROWN DR
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12903-4935
Country	:	US
Telephone Number	:	413-531-6752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	10/08/2012

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