Basic Information
Provider Information
NPI: 1629313309
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RUMPKE
FirstName: PAMELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 636256
Address2: CENTRAL CREDENTIALING
City: CINCINNATI
State: OH
PostalCode: 452636256
CountryCode: US
TelephoneNumber: 5132453104
FaxNumber: 5135855502
Practice Location
Address1: 234 GOODMAN ST
Address2:  
City: CINCINNATI
State: OH
PostalCode: 45219
CountryCode: US
TelephoneNumber: 5135850297
FaxNumber: 5135847217
Other Information
ProviderEnumerationDate: 12/06/2012
LastUpdateDate: 07/07/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100XCOA.13888-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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