Pam J. Waage, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R1041631 Issued in MN

Practice address

1245 15TH St N
Saint Cloud, MN 56303-1802

Phone

(320) 253-5220

Fax

(320) 203-2414

NPI assigned

Jun 8, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Pediatric Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487857249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6997 47TH AVE SE",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563049583",
            "telephone_number": "320-529-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 15TH ST N",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563031802",
            "telephone_number": "320-253-5220",
            "fax_number": "320-203-2414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAAGE",
        "first_name": "PAM",
        "middle_name": "J.",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R1041631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Karen Voss Haberle, DIRECTOR
• Lexi Voss
• Rachelle Marie Voss, LPCC
• Tririna Vue
• Brittany Nicole Vyskocil, LPN
• Donna Jane Wacker, LICSW
• Lydia M Wade, M.D.
• Adam Wagner
• Londa Sinness Wagner, MS, LMFT, IMH-E
• Meah Wagoner

• Pediatric Nurse Practitioner in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.