MEDICARE: PAM NILES NP

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
1	363L00000X	Nurse Practitioner	2067-033	WI

General Provider Information

NPI Number	:	1063460673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAM NILES NP

Provider Business Mailing Address
First Line	:	PO BOX 22487
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54305-2487
Country	:	US
Telephone Number	:	920-445-7226
Fax Number	:	920-445-7229

Provider Business Practice Location Address
First Line	:	2641 DEVELOPMENT DR
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-4240
Country	:	US
Telephone Number	:	920-338-6868
Fax Number	:	920-338-6869

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	09/05/2017

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Directions to “ PAM NILES NP” Practice Location

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