Provider Demographics
NPI:1104250059
Name:TABLER, PAMELA ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:TABLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8034 BLUESTEM AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-4000
Mailing Address - Country:US
Mailing Address - Phone:815-325-1882
Mailing Address - Fax:815-460-3296
Practice Address - Street 1:250 WATER STONE CIR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8313
Practice Address - Country:US
Practice Address - Phone:815-460-3299
Practice Address - Fax:815-460-3296
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAWAITING LICENSE#363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily