Provider Demographics
NPI:1508406653
Name:ORIAIFO, PAMELA FRU TANGE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:FRU TANGE
Last Name:ORIAIFO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 HAMLIN ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2805
Mailing Address - Country:US
Mailing Address - Phone:240-476-4081
Mailing Address - Fax:
Practice Address - Street 1:8702 HAMLIN ST
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2805
Practice Address - Country:US
Practice Address - Phone:240-476-4081
Practice Address - Fax:240-632-0737
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199916163W00000X, 363LF0000X, 363LP0808X
DCRN1026242363LF0000X, 363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily