Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 46896 | WI |
Y | 207X00000X | Orthopaedic Surgeon | 46896-20 | WI |
N | 207XS0106X | Orthopaedic Hand Surgeon | 46896 | WI |
NPI | 1326051459 |
---|---|
Provider Name | Pamela E Glennon |
First Address | Wausau, WI 54401-2950 |
Second Address | Wausau, WI 54401-2950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34564900 | (05) | WI |
I17274 | (02) | WI |