Provider Demographics
NPI:1154608867
Name:DWENGER, PAMALA ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:PAMALA
Middle Name:ANN
Last Name:DWENGER
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 1:3275 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2518
Mailing Address - Country:US
Mailing Address - Phone:419-999-9004
Mailing Address - Fax:419-999-9006
Practice Address - Street 1:3275 W ELM ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2518
Practice Address - Country:US
Practice Address - Phone:419-999-9004
Practice Address - Fax:419-999-9006
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11346NP363LP0200X
OHCNP.11346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics