Provider Demographics
NPI:1639386493
Name:STANO, PAMELA ANNE (APNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANNE
Last Name:STANO
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 NATURE TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-1676
Mailing Address - Country:US
Mailing Address - Phone:920-729-0454
Mailing Address - Fax:920-721-5137
Practice Address - Street 1:2100 COUNTY ROAD II
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-9317
Practice Address - Country:US
Practice Address - Phone:920-721-8623
Practice Address - Fax:920-721-5137
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2322-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily