MEDICARE: ANN LYNN PAMPALONE RN

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	70000080A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000325855	OTHER	IN	PROVIDER BCBS NUMBER

General Provider Information

NPI Number	:	1124181011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN LYNN PAMPALONE RN

Provider Business Mailing Address
First Line	:	1 CVS DR
Second Line	:	2100 HIGHLAND
City	:	WOONSOCKET
State	:	RI
Zip	:	02895-6146
Country	:	US
Telephone Number	:	401-770-1669
Fax Number	:	401-652-0276

Provider Business Practice Location Address
First Line	:	11200 W LINCOLN HWY
Second Line	:
City	:	MOKENA
State	:	IL
Zip	:	60448-8208
Country	:	US
Telephone Number	:	815-464-2171
Fax Number	:	815-464-2176

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	02/10/2011

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