Provider Demographics
NPI:1164512042
Name:GUTMAN, PAM M (RN, APN)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:M
Last Name:GUTMAN
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:DORRANCE 7TH FLOOR
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2265
Practice Address - Fax:856-342-8007
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNN92499363LN0000X
NJNR92499363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K6367OtherHEALTHNET
NJ2566419OtherUNITED HEALTHCARE
NJ60027019OtherHORIZON NJ HEALTH
NJ010005547OtherAMERICHOICE
NJ0082767Medicaid
NJ42285OtherUNIVERSITY HEALTH PLAN