Pamela Marie Clark, LPN
Individual provider Active NPI Licensed Practical Nurse · Smyrna, NY
NPI 1326307372 · NPPES record last updated May 11, 2012
Key facts
- NPI
- 1326307372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 242825 (NY)
- Practice address
- 3 South Street
Smyrna, NY 13464-0105 - Phone
- (607) 244-4605
- NPI assigned
- May 11, 2012
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 242825 | NY | Yes |
Addresses
Primary practice location
3 South Street
Smyrna, NY 13464-0105
Mailing address
PO Box 105
Smyrna, NY 13464-0105
Other providers in Smyrna, NY
All providers in Smyrna, NY · Licensed Practical Nurse in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2012. 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.