| Doctor Name: | MRS. PAMELA MARIE TIETZ |
| NPI Number: | 1619032158 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | R 109339-1 |
| Business Practice Address: | 301 2nd St Ne New Prague, MN - 560711709 |
| Business Phone Number: | 9527587228 |
| Business Fax Number: | |
| Mailing Address: | 618 Rolling Meadows Ln Se, NEW PRAGUE |
| State: | MN |
| Postal Code: | 560714022 |
| Phone Number: | 9527582908 |
| Fax Number: | |
| NPI Enumeration Date: | 12/26/2006 |
| NPI Last Update Date: | 12/18/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | R 109339-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |