Basic Information
| Provider Information | |||||||||
| NPI: | 1891024899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VICENTE | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 W UNION BLVD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180183708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108680104 | ||||||||
| FaxNumber: | 6108680204 | ||||||||
| Practice Location | |||||||||
| Address1: | 623 W UNION BLVD | ||||||||
| Address2: | SUITE 5 | ||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180183708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108680104 | ||||||||
| FaxNumber: | 6108680204 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2009 | ||||||||
| LastUpdateDate: | 12/22/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | SP001741G | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.