Healthcare Provider Details

I. General information

NPI: 1760764021
Provider Name (Legal Business Name): PAMELA JEAN BEHRENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 12/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN ST 4TH FL, SUITE B
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-7045
  • Fax: 413-794-7468
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number192101
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN192101
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: