Individual
PAMELA VANDERMARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2451 INTELLIPLEX DR STE 260, SHELBYVILLE, IN 46176-8580
(317) 398-0121
(317) 398-0538
Mailing address
30 W RAMPART ST STE 200, SHELBYVILLE, IN 46176-8846
(317) 398-0121
(317) 398-0538
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28154814A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71003764A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201042790
—
IN
Enumeration date
11/21/2011
Last updated
09/10/2020
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