Healthcare Provider Details

I. General information

NPI: 1346566213
Provider Name (Legal Business Name): PAMELA M SKERKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CRESCENT ST CENTER BEHAVIORAL HEALTH
MIDDLETOWN CT
06457-3654
US

IV. Provider business mailing address

28 CRESCENT ST CENTER BEHAVIORAL HEALTH
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-368-8760
  • Fax: 860-358-8754
Mailing address:
  • Phone: 860-368-8760
  • Fax: 860-358-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number898
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number000898
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: