Provider Demographics
NPI:1861415127
Name:ELSHERE, PAMELA G (PAC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:ELSHERE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-0900
Mailing Address - Country:US
Mailing Address - Phone:605-504-5195
Mailing Address - Fax:605-504-5150
Practice Address - Street 1:725 E FIGZEL CT
Practice Address - Street 2:SUITE 100
Practice Address - City:TEA
Practice Address - State:SD
Practice Address - Zip Code:57064-2276
Practice Address - Country:US
Practice Address - Phone:605-368-9899
Practice Address - Fax:605-368-5089
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0567363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD101879Medicare PIN