| NPI | 1124436118 | 
|---|---|
| Former Name | PAMELA SUE WILLE | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 5944-33)  | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 143303-30)  | 
| Enumeration Date | 2014-07-23 | 
| Last Update Date | 2021-08-25 |