Individual
MS. PAMELA JEAN ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Mailing address
1 GUTHRIE SQ, SAYRE, PA 18840-1625
(570) 888-5858
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN318594L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430066788
RR MEDICARE PIN
PA
01
—
CC9269
RR MEDICARE GROUP
PA
01
—
GU039832
MEDICARE GROUP
PA
Enumeration date
03/21/2006
Last updated
07/29/2011
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