Provider Demographics
NPI:1336133917
Name:ZISSELMAN, PAMELA M (CRNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:M
Last Name:ZISSELMAN
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 1:6334 CEDAR LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3898
Mailing Address - Country:US
Mailing Address - Phone:410-531-2355
Mailing Address - Fax:410-531-7041
Practice Address - Street 1:6334 CEDAR LN
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3898
Practice Address - Country:US
Practice Address - Phone:410-531-2355
Practice Address - Fax:410-531-7041
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP001583H363L00000X
MDR222718363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAZI02272Medicare ID - Type Unspecified
PAS45346Medicare UPIN