1720267966 NPI number — PAMELA M SIGMUND PA-C

Table of content: PAMELA M SIGMUND PA-C (NPI 1720267966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720267966 NPI number — PAMELA M SIGMUND PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIGMUND
Provider First Name:
PAMELA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720267966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9170
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50306-9170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-633-3600
Provider Business Mailing Address Fax Number:
515-633-3838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5880 UNIVERSITY AVE STE. 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-8209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-633-3600
Provider Business Practice Location Address Fax Number:
515-288-0840
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  002074 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720267966 . This is a "NPI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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