Provider Demographics
NPI:1134665268
Name:NEWCOMB, PAMELA JEAN
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:NEWCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3197 COUNTY RD N
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-9734
Mailing Address - Country:US
Mailing Address - Phone:920-723-7654
Mailing Address - Fax:
Practice Address - Street 1:N3197 COUNTY RD N
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-9734
Practice Address - Country:US
Practice Address - Phone:920-723-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60265163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health