Provider Demographics
NPI:1285681726
Name:DREXLER-LOPEZ, PAMELA (CNM)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:DREXLER-LOPEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 HUNTINGTON RD
Mailing Address - Street 2:#1
Mailing Address - City:HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01035-9601
Mailing Address - Country:US
Mailing Address - Phone:413-585-0498
Mailing Address - Fax:
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-585-0498
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163392367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA163392OtherCONNECTICARE
MA04-2508583OtherUNITED HEALTH PLAN
MACN0095OtherBCBS MA
R34493Medicare UPIN
RN0081Medicare ID - Type Unspecified