Provider Demographics
NPI:1679594154
Name:SHAPIRO, PAMELA JEAN (APRN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JEAN
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2120 S RESERVE ST
Mailing Address - Street 2:PMB 118
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6451
Mailing Address - Country:US
Mailing Address - Phone:406-829-1744
Mailing Address - Fax:406-829-1277
Practice Address - Street 1:2120 S RESERVE ST
Practice Address - Street 2:PMB 118
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6451
Practice Address - Country:US
Practice Address - Phone:406-829-1744
Practice Address - Fax:406-829-1277
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN29990363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health