Provider Demographics
NPI:1205367117
Name:WERTHEIM, PAMELA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SEA LN
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1954
Mailing Address - Country:US
Mailing Address - Phone:860-463-5615
Mailing Address - Fax:
Practice Address - Street 1:120 SEA LN
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1954
Practice Address - Country:US
Practice Address - Phone:860-463-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily