Provider Demographics
NPI:1255390241
Name:BARR, PAMELLA SUE (APRN)
Entity type:Individual
Prefix:
First Name:PAMELLA
Middle Name:SUE
Last Name:BARR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAMELLA
Other - Middle Name:SUE
Other - Last Name:ROHDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 PLEASANT ST
Mailing Address - Street 2:POWELL 206
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1406
Mailing Address - Country:US
Mailing Address - Phone:515-241-5100
Mailing Address - Fax:
Practice Address - Street 1:1200 PLEASANT ST
Practice Address - Street 2:POWELL 206
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1406
Practice Address - Country:US
Practice Address - Phone:515-241-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110313363L00000X
IAA-050977363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1255390241Medicaid
IAP01353130OtherRR MEDICARE
NE110313OtherLICENSE
IA1255390241Medicaid
NE110313OtherLICENSE
S75022Medicare UPIN
IAI22140021Medicare PIN