Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN0013591 | FL |
NPI | 1124118245 |
---|---|
Provider Name | Dr. Pamela Loretta Nielsen |
First Address | Miami, FL 33173-2534 |
Second Address | Miami, FL 33173-2534 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 08/07/2007 |