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Individual
MS. PAMELA SUE SHODA
Active
Individual
MS. PAMELA SUE SHODA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002051A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000386476
BCBS
—
01
—
71002051B
CSR LICENSE NUMBER
IN
01
—
P00309869
MEDICARE RAILROAD
—
Enumeration date
09/20/2006
Last updated
03/07/2023
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