Provider Demographics
NPI:1104488154
Name:OURADA, PAMELA ANN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
Last Name:OURADA
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:BERSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2603 S 15TH ST
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6230
Mailing Address - Country:US
Mailing Address - Phone:920-627-4309
Mailing Address - Fax:
Practice Address - Street 1:2603 S 15TH ST
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6230
Practice Address - Country:US
Practice Address - Phone:920-627-4309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-30
Last Update Date:2019-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI116771163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty