Provider Demographics
NPI:1801067483
Name:MORRISON, PAMELA MUNDY (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MUNDY
Last Name:MORRISON
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11814 KING WILLIAM RD
Mailing Address - Street 2:P O BOX 213
Mailing Address - City:AYLETT
Mailing Address - State:VA
Mailing Address - Zip Code:23009-4103
Mailing Address - Country:US
Mailing Address - Phone:804-769-3002
Mailing Address - Fax:804-769-1253
Practice Address - Street 1:11814 KING WILLIAM RD
Practice Address - Street 2:
Practice Address - City:AYLETT
Practice Address - State:VA
Practice Address - Zip Code:23009-4103
Practice Address - Country:US
Practice Address - Phone:804-769-3002
Practice Address - Fax:804-769-1253
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167720363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
017358V24Medicare PIN
VAVAA102918Medicare PIN