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General NPI Number Information
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NPI Number | 1487948626
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Entity Type | Individual
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Provider Name | PAMELA R DEBACK NP
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Gender | Female
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 2514 S 102ND ST STE 160
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City | WEST ALLIS
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State | WI
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Zip | 53227-2142
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Country | US
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Telephone | 414-225-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 6860 DALLAS PKWY STE 550
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City | PLANO
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State | TX
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Zip | 75024-4252
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Country | US
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Telephone | 414-688-5751
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4409
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 440933
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License Number State | WI
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