Healthcare Provider Details

I. General information

NPI: 1174635429
Provider Name (Legal Business Name): PAMELA S MUCHA C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 SCHILLING RD
HUNT VALLEY MD
21031-1191
US

IV. Provider business mailing address

PO BOX 631568
BALTIMORE MD
21263-1568
US

V. Phone/Fax

Practice location:
  • Phone: 410-771-9220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR069188
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: