Provider Demographics
NPI:1447887534
Name:VOELKERS, PAMELA GOOMAS (RD)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GOOMAS
Last Name:VOELKERS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 HERON DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-2879
Mailing Address - Country:US
Mailing Address - Phone:262-210-0560
Mailing Address - Fax:
Practice Address - Street 1:1020 N 12TH STREET
Practice Address - Street 2:OHC 4
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-1308
Practice Address - Country:US
Practice Address - Phone:414-219-5944
Practice Address - Fax:414-219-5914
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI194229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered