Provider Demographics
NPI:1376837385
Name:GUPTA, PAMELA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:GUPTA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:VEROSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 SANSOM ST
Mailing Address - Street 2:239 THOMPSON BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5002
Mailing Address - Country:US
Mailing Address - Phone:215-955-6844
Mailing Address - Fax:215-923-6225
Practice Address - Street 1:1020 SANSOM ST
Practice Address - Street 2:239 THOMPSON BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5002
Practice Address - Country:US
Practice Address - Phone:215-955-6844
Practice Address - Fax:215-923-6225
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011362363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care