Provider Demographics
NPI:1487053062
Name:VETTER, PAMELA J (ACNS-BC, APNP)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:J
Last Name:VETTER
Suffix:
Gender:F
Credentials:ACNS-BC, APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4100
Mailing Address - Country:US
Mailing Address - Phone:715-847-2391
Mailing Address - Fax:715-847-2869
Practice Address - Street 1:215 N 28TH AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4100
Practice Address - Country:US
Practice Address - Phone:715-847-2391
Practice Address - Fax:715-847-2869
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2014004212364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5938-33OtherADVANCED PRACTICE NURSE PRESCRIBER