Pamela Anderson
Individual provider Active NPI General Practice Registered Nurse · Newark, NJ
NPI 1013600162 · NPPES record last updated Jun 2, 2023
Key facts
- NPI
- 1013600162
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Registered Nurse 163WG0000X
- License
- 26NN08240300 (NJ)
- Practice address
- 354 Doremus Ave
Newark, NJ 07105-4882 - Phone
- (973) 274-6816
- NPI assigned
- Jun 2, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26NN08240300 | NJ | MD | Adult Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Medicine Physician | 207QA0505X | 26NN08240300 | NJ | |
| General Practice Registered Nurse | 163WG0000X | 26NN08240300 | NJ | Yes |
Addresses
Primary practice location
354 Doremus Ave
Newark, NJ 07105-4882
Mailing address
354 Doremus Ave
Newark, NJ 07105-4882
Phone (973) 274-6816
Other practice location 1
564 Varsity Rd
South Orange, NJ 07079-2631
Phone (609) 292-4036 ext. 5206
Other providers in Newark, NJ
- Amanda Marie Andersen
- Audrey Anderson
- Chepell Anderson
- Iyana Anderson
- Kisha Tamara Anderson
- Shayvonne Anderson
- Falecia Andino
- Andrew Andonov
- Kathleen Andrade
- Tammy Andrade
All providers in Newark, NJ · General Practice Registered Nurse in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.