Provider Demographics
NPI:1255687604
Name:MANSFIELD, PAMELA JEAN (RN, WCC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:RN, WCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-4330
Mailing Address - Country:US
Mailing Address - Phone:423-588-0616
Mailing Address - Fax:414-885-0544
Practice Address - Street 1:4014 S 5TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-4330
Practice Address - Country:US
Practice Address - Phone:423-588-0616
Practice Address - Fax:414-885-0544
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116131-030163W00000X
WI4180812163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care