Provider Demographics
NPI:1861451627
Name:HAYWARD, PAMELA M (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:HAYWARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 W RESEARCH DR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3449
Mailing Address - Country:US
Mailing Address - Phone:414-543-3333
Mailing Address - Fax:414-302-1040
Practice Address - Street 1:10501 W RESEARCH DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3449
Practice Address - Country:US
Practice Address - Phone:414-543-3333
Practice Address - Fax:414-302-1040
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2569363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390807236DCOtherUNITY
WI14208OtherDEAN
WI41269700Medicaid
WI41269700Medicaid
WI0012-26065Medicare ID - Type Unspecified