Provider Demographics
NPI:1588960660
Name:POPPENHAGEN, PAMELA DENISE (RN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:POPPENHAGEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 E MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7732
Mailing Address - Country:US
Mailing Address - Phone:507-345-8591
Mailing Address - Fax:507-345-5023
Practice Address - Street 1:227 E MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7732
Practice Address - Country:US
Practice Address - Phone:507-345-8591
Practice Address - Fax:507-345-5023
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-145412-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse