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General NPI Number Information
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NPI Number | 1255687604
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Entity Type | Individual
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Provider Name | PAMELA JEAN MANSFIELD RN, WCC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2012
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 4014 S 5TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53207-4330
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Country | US
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Telephone | 423-588-0616
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Fax | 414-885-0544
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Provider Business Mailing Address
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Address Line | 4014 S 5TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53207-4330
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Country | US
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Telephone | 423-588-0616
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Fax | 414-885-0544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 116131-030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number | 4180812
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License Number State | WI
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