Provider Demographics
NPI:1558384933
Name:HAERR, PAMELA JOYCE
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:JOYCE
Last Name:HAERR
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 1:2020 W HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3741
Mailing Address - Country:US
Mailing Address - Phone:312-572-4690
Mailing Address - Fax:312-572-4602
Practice Address - Street 1:102 CREEK CT
Practice Address - Street 2:
Practice Address - City:PROSPECT HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60070-1305
Practice Address - Country:US
Practice Address - Phone:312-572-4690
Practice Address - Fax:312-572-4659
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000124363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP63461Medicare UPIN