Provider Demographics
NPI:1134463862
Name:POWELL, PAMELA D (APNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:POWELL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:D
Other - Last Name:SAMPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 W GOOD HOPE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2042
Mailing Address - Country:US
Mailing Address - Phone:414-352-3100
Mailing Address - Fax:
Practice Address - Street 1:6425 W MEQUON RD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-1855
Practice Address - Country:US
Practice Address - Phone:262-242-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5158363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI462364957Medicare PIN
WI019940737Medicare PIN