Provider Demographics
NPI:1962670067
Name:PAMELA JEAN ELMER
Entity Type:Organization
Organization Name:PAMELA JEAN ELMER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:CFM
Authorized Official - Phone:920-235-1620
Mailing Address - Street 1:511 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4908
Mailing Address - Country:US
Mailing Address - Phone:920-235-1620
Mailing Address - Fax:
Practice Address - Street 1:511 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-4908
Practice Address - Country:US
Practice Address - Phone:920-235-1620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5441740001Medicare NSC