Provider Demographics
NPI:1023104270
Name:LIST, PAMELA H (APRN)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:H
Last Name:LIST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EAST DECATUR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:NE
Mailing Address - Zip Code:68788-1566
Mailing Address - Country:US
Mailing Address - Phone:402-372-2477
Mailing Address - Fax:402-372-6770
Practice Address - Street 1:500 EAST DECATUR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1566
Practice Address - Country:US
Practice Address - Phone:402-372-2477
Practice Address - Fax:402-372-6770
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110213363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE250862OtherMIDLANDS CHOICE
NED03616OtherBCBS OF NEBRASKA
NED03616OtherBCBS OF NEBRASKA
NE269165Medicare PIN