Provider Demographics
NPI:1538202262
Name:PRINCE, PAMELA CHARLENE (NP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:CHARLENE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4059 N 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6601
Mailing Address - Country:US
Mailing Address - Phone:414-445-7071
Mailing Address - Fax:
Practice Address - Street 1:949 N 9TH ST
Practice Address - Street 2:HEALTH SERVICES UNIT
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1422
Practice Address - Country:US
Practice Address - Phone:414-226-7136
Practice Address - Fax:414-226-7159
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI72997-030363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI12610501OtherCAQH