Provider Demographics
NPI:1215549787
Name:DEAN, PAMELA (LVN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18009 POMELO LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1926
Mailing Address - Country:US
Mailing Address - Phone:512-988-4141
Mailing Address - Fax:
Practice Address - Street 1:3750 GATTIS SCHOOL RD STE 900
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4651
Practice Address - Country:US
Practice Address - Phone:512-813-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310584164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse