Provider Demographics
NPI:1104675362
Name:SHORT, PAMELA ANNE (MSN-ED, RN, CIC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:SHORT
Suffix:
Gender:F
Credentials:MSN-ED, RN, CIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 AOLOA ST APT 711
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-3011
Mailing Address - Country:US
Mailing Address - Phone:928-899-2688
Mailing Address - Fax:
Practice Address - Street 1:459 PATTERSON ROAD
Practice Address - Street 2:QUALITY AND PATIENT SAFETY
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:928-899-2688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN085233163WI0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WI0600XNursing Service ProvidersRegistered NurseInfection Control