Provider Demographics
NPI:1689059610
Name:MIGLIACCIO, PAMELA LAURA (APRN, CNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:LAURA
Last Name:MIGLIACCIO
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045-0155
Mailing Address - Country:US
Mailing Address - Phone:405-408-4853
Mailing Address - Fax:405-945-9151
Practice Address - Street 1:1520 S BRYANT AVE
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-6028
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:405-945-9151
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-20
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK92469363LF0000X
OKR00469363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty