Provider Demographics
NPI:1174635429
Name:MUCHA, PAMELA S (CRNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:S
Last Name:MUCHA
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:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9 SCHILLING RD
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1191
Practice Address - Country:US
Practice Address - Phone:410-771-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR069188363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS138/0098OtherCAREFIRST REGIONAL
MDKJ15GB-52837403OtherCAREFIRST MARYLAND
MDS138-0098OtherCAREFIRST REGIONAL
MDKJ15GB/52837403OtherCAREFIRST MARYLAND
MDS138-0098OtherCAREFIRST REGIONAL
MDKJ15GB-52837403OtherCAREFIRST MARYLAND