Provider Demographics
NPI:1568762904
Name:KELLOGG, PAMELA (PHN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 18TH AVE NW STE A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-1988
Mailing Address - Country:US
Mailing Address - Phone:507-437-9770
Mailing Address - Fax:507-434-2695
Practice Address - Street 1:1301 18TH AVE NW STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-1988
Practice Address - Country:US
Practice Address - Phone:507-437-9770
Practice Address - Fax:507-434-2695
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR120874-6163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health