Individual
PAMELA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
354 DOREMUS AVE, NEWARK, NJ 07105-4882
(973) 274-6816
Mailing address
354 DOREMUS AVE, NEWARK, NJ 07105-4882
(973) 274-6816
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
26NN08240300
NJ
207QA0505X
Adult Medicine Physician
26NN08240300
NJ
Other
Enumeration date
06/02/2023
Last updated
06/02/2023
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