Provider Demographics
NPI:1902138621
Name:NEUMANN, PAMELA L (APRN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:L
Last Name:NEUMANN
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 HEBRON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2410
Mailing Address - Country:US
Mailing Address - Phone:860-696-2250
Mailing Address - Fax:860-696-2260
Practice Address - Street 1:676 HEBRON AVE STE 1
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2410
Practice Address - Country:US
Practice Address - Phone:860-696-2250
Practice Address - Fax:860-696-2260
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT073588163W00000X
CT004227363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1902138621OtherNPI