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NPI Code Detail

MEDICARE: PAMELA S. VIPOND APRN

MEDICARE: PAMELA S. VIPOND APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner041218923IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285739151
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA S. VIPOND APRN
Provider Business Mailing Address
First Line : 400 JOHN DEERE RD BLDG 1
Second Line :
City : MOLINE
State : IL
Zip : 61265-6898
Country : US
Telephone Number : 309-517-3036
Fax Number : 309-797-1088
Provider Business Practice Location Address
First Line : 400 JOHN DEERE RD BLDG 1
Second Line :
City : MOLINE
State : IL
Zip : 61265-6898
Country : US
Telephone Number : 309-517-3036
Fax Number : 309-797-1088
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 06/23/2016

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Directions to “ PAMELA S. VIPOND APRN” Practice Location

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