Individual
PAM MARIE BURBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 266-1209
(541) 266-4515
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 266-1209
(541) 266-4515
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
084053617RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1407812365
NBMC GROUP NPI
OR
01
—
930635514
NBMC GROUP TAX ID FOR BILLING
OR
01
—
R0000WFBTV
NBMC GROUP MEDICARE NUMBER
OR
Enumeration date
03/11/2011
Last updated
05/20/2013
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