Provider Demographics
NPI:1154731487
Name:SHALLOWAY, PAMELA (RN, CRNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:SHALLOWAY
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6123 MONTROSE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4860
Mailing Address - Country:US
Mailing Address - Phone:301-816-2676
Mailing Address - Fax:301-816-2628
Practice Address - Street 1:6123 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4860
Practice Address - Country:US
Practice Address - Phone:301-816-2676
Practice Address - Fax:301-816-2628
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR117774363LF0000X
DCRN60369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR117774OtherLICENSE
DCRN60369OtherLICENSE