Healthcare Provider Details

I. General information

NPI: 1013950187
Provider Name (Legal Business Name): PAMELA MARIE GAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 MIDDLE TPKE E
MANCHESTER CT
06040-3731
US

IV. Provider business mailing address

PO BOX 343
WINDHAM CT
06280-0343
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-3888
  • Fax: 860-645-4132
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number003378
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: