Individual provider · NPI-1

Pamela Anderson

Registered Nurse, General Practice · Newark, NJ

NPI number1013600162
StatusActive
Last updated in NPPESJun 2, 2023

Details

NPI
1013600162
Entity type
Individual (NPI-1)
Name
Pamela Anderson
Sex
Female
Sole proprietor
No
Enumeration date
Jun 2, 2023
Certification date
May 5, 2023
Last updated
Jun 2, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WG0000X Registered Nurse, General Practice26NN08240300NJYes
207QA0505X Family Medicine, Adult Medicine26nn08240300NJ

Practice location

354 Doremus Ave
Newark, NJ 07105-4882

Phone 973-274-6816

Mailing address

354 Doremus Ave
Newark, NJ 07105-4882

Phone 973-274-6816

Other practice locations

564 Varsity Rd
South Orange, NJ 07079-2631

Phone 609-292-4036 · Fax 609-341-3399

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