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General NPI Number Information
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NPI Number | 1487857249
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Entity Type | Individual
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Provider Name | PAM J. WAAGE CPNP
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Gender | Female
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1245 15TH ST N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-1802
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Country | US
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Telephone | 320-253-5220
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Fax | 320-203-2414
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Provider Business Mailing Address
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Address Line | 6997 47TH AVE SE
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City | SAINT CLOUD
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State | MN
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Zip | 56304-9583
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Country | US
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Telephone | 320-529-0051
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | R1041631
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License Number State | MN
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