Provider Demographics
NPI:1730381591
Name:THUL-IMMLER, PAMELA J (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:THUL-IMMLER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 MADELINE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9651
Mailing Address - Country:US
Mailing Address - Phone:715-358-5066
Mailing Address - Fax:715-358-5480
Practice Address - Street 1:9060 MADELINE LAKE RD
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9651
Practice Address - Country:US
Practice Address - Phone:715-358-5066
Practice Address - Fax:715-358-5480
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1370-033363LG0600X
WI363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI439-188-00Medicaid
WIR80142Medicare UPIN