Provider Demographics
NPI:1326130766
Name:KOLP, PAMELA SIEBER (APRN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SIEBER
Last Name:KOLP
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 1:92 NEW LONDON TPKE
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-3835
Mailing Address - Fax:860-823-1782
Practice Address - Street 1:92 NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-889-3835
Practice Address - Fax:860-823-1782
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002594363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
230002594CT01OtherBLUECARE FAMILY PLAN
259400OtherCONNECTICARE
2V6555OtherHEALTHNET
400002594CT01OtherANTHEM BLUE CROSS
230002594CT01OtherHUSKY B