Provider Demographics
NPI:1053693226
Name:MARMON, PAMELA M (RN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:M
Last Name:MARMON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 COUNTY ROUTE 64
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:NY
Mailing Address - Zip Code:13114-4219
Mailing Address - Country:US
Mailing Address - Phone:315-963-4223
Mailing Address - Fax:315-963-4372
Practice Address - Street 1:179 COUNTY ROUTE 64
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:NY
Practice Address - Zip Code:13114-4219
Practice Address - Country:US
Practice Address - Phone:315-963-4223
Practice Address - Fax:315-963-4372
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298244163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool