Individual
PAMELA ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
11202 79 STREET, PLEASANT PRAIRIE, WI 53158
(262) 694-8468
Mailing address
11202 79 STREET, PLEASANT PRAIRIE, WI 53158
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
67931-030
WI
163WH0200X
Home Health Registered Nurse
67831-030
WI
Other
Enumeration date
11/20/2006
Last updated
11/15/2007
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