Individual
PAMELA A MENTINK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3400 UNION AVE, SHEBOYGAN, WI 53081-8426
(920) 282-2530
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(920) 282-2530
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2354-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000703
—
WI
01
—
2354-23
WI LICENSE
WI
Enumeration date
10/09/2008
Last updated
10/03/2023
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