Provider Demographics
NPI:1598018079
Name:NELSON, PAMELA (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:NELSON
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 1:12955 WENDT RD
Mailing Address - Street 2:
Mailing Address - City:SURING
Mailing Address - State:WI
Mailing Address - Zip Code:54174-9352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12955 WENDT RD
Practice Address - Street 2:
Practice Address - City:SURING
Practice Address - State:WI
Practice Address - Zip Code:54174-9352
Practice Address - Country:US
Practice Address - Phone:920-842-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-20
Last Update Date:2012-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17035530163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse