Provider Demographics
NPI:1467618827
Name:WARREN, PAMELA NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:NICOLE
Last Name:WARREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 E MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-2604
Mailing Address - Country:US
Mailing Address - Phone:203-757-2348
Mailing Address - Fax:
Practice Address - Street 1:2247 E MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-2604
Practice Address - Country:US
Practice Address - Phone:203-757-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002123363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical