Provider Demographics
NPI:1366748188
Name:WENTWORTH, PAMELA SUZANNE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUZANNE
Last Name:WENTWORTH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MISS
Other - First Name:PAMELA
Other - Middle Name:S
Other - Last Name:FIRMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 933432
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0039
Mailing Address - Country:US
Mailing Address - Phone:937-641-5072
Mailing Address - Fax:937-641-6129
Practice Address - Street 1:3333 W TECH RD STE 220
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-0956
Practice Address - Country:US
Practice Address - Phone:937-885-4475
Practice Address - Fax:937-885-3671
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2619002363LP0200X, 363L00000X
OHAPRN.CNP.0032838363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0008997Medicaid
FL013225400Medicaid
FLARNP2619002OtherMEDICAL LICENSE