Provider Demographics
NPI:1124181011
Name:PAMPALONE, ANN LYNN (RN)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LYNN
Last Name:PAMPALONE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CVS DR
Mailing Address - Street 2:2100 HIGHLAND
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-6146
Mailing Address - Country:US
Mailing Address - Phone:401-770-1669
Mailing Address - Fax:401-652-0276
Practice Address - Street 1:11200 W LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8208
Practice Address - Country:US
Practice Address - Phone:815-464-2171
Practice Address - Fax:815-464-2176
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000080A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000325855OtherPROVIDER BCBS NUMBER
IN405160FFMedicare ID - Type UnspecifiedPROVIDER MEDICARE NUMBER
IN000000325855OtherPROVIDER BCBS NUMBER