Healthcare Provider Details

I. General information

NPI: 1851565147
Provider Name (Legal Business Name): PAMELA DEL POZO-WALDRON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 STATE ST
NEW LONDON CT
06320-6397
US

IV. Provider business mailing address

165 STATE ST
NEW LONDON CT
06320-6397
US

V. Phone/Fax

Practice location:
  • Phone: 860-443-0036
  • Fax:
Mailing address:
  • Phone: 860-443-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number003757
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number003757
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number073430-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: