Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 110213 | NE |
N | 363LP2300X | Nurse Practitioner - Primary Care | 110213 | NE |
NPI | 1023104270 |
---|---|
Provider Name | Ms. Pamela H List |
First Address | West Point, NE 68788-1566 |
Second Address | West Point, NE 68788-1566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 20/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250862 | MIDLANDS CHOICE (01) | NE |
D03616 | BCBS OF NEBRASKA (01) | NE |
S61555 | (02) |