Provider Demographics
NPI:1902641830
Name:MARTIN, PAMELA ADASSA (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ADASSA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:ADASSA
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:20 BOOKER BLVD
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-1507
Mailing Address - Country:US
Mailing Address - Phone:631-375-6636
Mailing Address - Fax:
Practice Address - Street 1:20 BOOKER BLVD
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-1507
Practice Address - Country:US
Practice Address - Phone:631-375-6636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY610048-1163WC1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development