Provider Demographics
NPI:1588623854
Name:EHRLICH, PAM M (LPN)
Entity Type:Individual
Prefix:MISS
First Name:PAM
Middle Name:M
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N78W12555 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4403
Mailing Address - Country:US
Mailing Address - Phone:262-305-1378
Mailing Address - Fax:
Practice Address - Street 1:N78W12555 FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4403
Practice Address - Country:US
Practice Address - Phone:262-305-1378
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26029-031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse