Provider Demographics
NPI:1215140637
Name:KANCE BROLIN, PAMELA D (APRN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:D
Last Name:KANCE BROLIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 US HIGHWAY 1
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-1966
Mailing Address - Country:US
Mailing Address - Phone:732-438-3666
Mailing Address - Fax:732-438-1660
Practice Address - Street 1:4250 US HIGHWAY 1
Practice Address - Street 2:SUITE 1
Practice Address - City:MONMOUTH JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08852-1966
Practice Address - Country:US
Practice Address - Phone:732-438-3666
Practice Address - Fax:732-438-1660
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR04738000163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health