Provider Demographics
NPI:1174797971
Name:ZIEGENFUSS, PAMELA K (SW)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:K
Last Name:ZIEGENFUSS
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12378 W DELMAR ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-5849
Mailing Address - Country:US
Mailing Address - Phone:208-362-1172
Mailing Address - Fax:
Practice Address - Street 1:12378 W DELMAR ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5849
Practice Address - Country:US
Practice Address - Phone:208-362-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID00000210663747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant