Provider Demographics
NPI:1366993685
Name:HAIRE, PAMELA JOANN EDWARDS (FNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOANN EDWARDS
Last Name:HAIRE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5750 W THUNDERBIRD RD
Mailing Address - Street 2:STE. C-300
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4660
Mailing Address - Country:US
Mailing Address - Phone:602-938-2848
Mailing Address - Fax:602-938-4401
Practice Address - Street 1:5750 W THUNDERBIRD RD
Practice Address - Street 2:STE. C-300
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4660
Practice Address - Country:US
Practice Address - Phone:602-938-2848
Practice Address - Fax:602-938-4401
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZRN167471363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily