Provider Demographics
NPI:1518767227
Name:DETHLEFS, PAMELA SUE
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:SUE
Last Name:DETHLEFS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31308 IMPERIAL RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:NE
Mailing Address - Zip Code:68869-3007
Mailing Address - Country:US
Mailing Address - Phone:308-440-2330
Mailing Address - Fax:
Practice Address - Street 1:31308 IMPERIAL RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:NE
Practice Address - Zip Code:68869-3007
Practice Address - Country:US
Practice Address - Phone:308-440-2330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant