1275774457 NPI number — MS. PAMELA CAMPBELL PHELPS NP - NURSE PRACTITIO

Table of content: MS. PAMELA CAMPBELL PHELPS NP - NURSE PRACTITIO (NPI 1275774457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275774457 NPI number — MS. PAMELA CAMPBELL PHELPS NP - NURSE PRACTITIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHELPS
Provider First Name:
PAMELA
Provider Middle Name:
CAMPBELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP - NURSE PRACTITIO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
PAMELA
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP NURSE PRACTITIONE
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275774457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SPECTRUM 8695 SPECTRUM CENTER COURT
Provider Second Line Business Mailing Address:
SHARP - EMPLOYEE OCCUPATIONA HEALTH
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-499-5259
Provider Business Mailing Address Fax Number:
858-499-5317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SPECTRUM 8695 SPECTRUM CENTER CT.
Provider Second Line Business Practice Location Address:
SHARP EMPLOYEE OCCUPATIONAL HEALTH
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-499-5259
Provider Business Practice Location Address Fax Number:
858-499-5317
Provider Enumeration Date:
03/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com