Provider Demographics
NPI:1194080333
Name:BLUNDELL, PAMELA R (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:R
Last Name:BLUNDELL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71107 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7243
Mailing Address - Country:US
Mailing Address - Phone:985-893-2580
Mailing Address - Fax:
Practice Address - Street 1:71107 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7243
Practice Address - Country:US
Practice Address - Phone:985-893-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP06940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily