Healthcare Provider Details

I. General information

NPI: 1770569485
Provider Name (Legal Business Name): PAMELA M SISSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 BARNES RD STE 2 PYRAMID PRIMARY CARE PHYSICIANS PC
WALLINGFORD CT
06492-1885
US

IV. Provider business mailing address

97 BARNES RD STE 2 PYRAMID PRIMARY CARE PHYSICIANS PC
WALLINGFORD CT
06492-1885
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-0355
  • Fax: 203-265-7413
Mailing address:
  • Phone: 203-265-0355
  • Fax: 203-265-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number001911
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number001911
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: