Basic Information
| Provider Information | |||||||||
| NPI: | 1538576202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORKMAN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | LSU ATHLETIC ADMININSTRATION BLD | ||||||||
| Address2: | ATHLETIC TRAINING DEPT | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708030001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255782050 | ||||||||
| FaxNumber: | 2255783924 | ||||||||
| Practice Location | |||||||||
| Address1: | LSU ATHLETIC ADMINISTRATION BLD | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708030001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2255782050 | ||||||||
| FaxNumber: | 2255783924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2014 | ||||||||
| LastUpdateDate: | 07/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | ATH.200339 | LA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.