Provider Demographics
NPI:1225756000
Name:KOOSMANN, PAMELA S (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:KOOSMANN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CAMELOT LN LOT 123
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-8625
Mailing Address - Country:US
Mailing Address - Phone:715-296-0702
Mailing Address - Fax:715-949-1026
Practice Address - Street 1:32 CAMELOT LN LOT 123
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-8625
Practice Address - Country:US
Practice Address - Phone:715-296-0702
Practice Address - Fax:715-949-1026
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122555-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health