Provider Demographics
NPI:1386765055
Name:STAUBER, PAMELA L I (LMT)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:STAUBER
Suffix:I
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 12TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3159
Mailing Address - Country:US
Mailing Address - Phone:503-930-3695
Mailing Address - Fax:503-585-3041
Practice Address - Street 1:2744 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3159
Practice Address - Country:US
Practice Address - Phone:503-930-3695
Practice Address - Fax:503-585-3041
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7527246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other