Provider Demographics
NPI:1093117004
Name:MCMULLAN, PAMELA (CRNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MCMULLAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11116 MEDICAL CAMPUS RD STE 2989
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6710
Mailing Address - Country:US
Mailing Address - Phone:301-766-7600
Mailing Address - Fax:
Practice Address - Street 1:11116 MEDICAL CAMPUS RD STE 2989
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-766-7600
Practice Address - Fax:301-797-4976
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR104266363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner