Healthcare Provider Details

I. General information

NPI: 1972672368
Provider Name (Legal Business Name): PAMELA K KURKUL ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 RIVERDALE ST
W SPRINGFIELD MA
01089-4620
US

IV. Provider business mailing address

58 CENTRAL ST
GARDNER MA
01440-1608
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 978-821-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN142981
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: