Healthcare Provider Details

I. General information

NPI: 1255687604
Provider Name (Legal Business Name): PAMELA JEAN MANSFIELD RN, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 S 5TH ST
MILWAUKEE WI
53207-4330
US

IV. Provider business mailing address

4014 S 5TH ST
MILWAUKEE WI
53207-4330
US

V. Phone/Fax

Practice location:
  • Phone: 423-588-0616
  • Fax: 414-885-0544
Mailing address:
  • Phone: 423-588-0616
  • Fax: 414-885-0544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116131-030
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number4180812
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: