Provider Demographics
NPI:1013732692
Name:WILEY, PAMALA LEE (RN,BSN,IBCLC)
Entity type:Individual
Prefix:
First Name:PAMALA
Middle Name:LEE
Last Name:WILEY
Suffix:
Gender:F
Credentials:RN,BSN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 RIVER RD APT 24
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1859
Mailing Address - Country:US
Mailing Address - Phone:810-357-2603
Mailing Address - Fax:
Practice Address - Street 1:1660 RIVER RD APT 24
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1859
Practice Address - Country:US
Practice Address - Phone:810-357-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704204894163WN0002X
MIL-49729163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care