Provider Demographics
NPI:1972825040
Name:ROCKLAGE, PAMELA L (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:ROCKLAGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:NORELIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:15060 DECEMBER WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068
Mailing Address - Country:US
Mailing Address - Phone:612-343-3265
Mailing Address - Fax:612-343-3267
Practice Address - Street 1:801 PARK AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1136
Practice Address - Country:US
Practice Address - Phone:612-343-3265
Practice Address - Fax:612-343-3267
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR72595-8171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator