Provider Demographics
NPI:1679850408
Name:CIPRIANO, PAMELA M (DNP, APRN)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:M
Last Name:CIPRIANO
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 MAIN ST
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:THOMASTON
Mailing Address - State:CT
Mailing Address - Zip Code:06787-1747
Mailing Address - Country:US
Mailing Address - Phone:860-880-2525
Mailing Address - Fax:860-880-8253
Practice Address - Street 1:131 MAIN ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:THOMASTON
Practice Address - State:CT
Practice Address - Zip Code:06787-1747
Practice Address - Country:US
Practice Address - Phone:860-880-2525
Practice Address - Fax:860-880-8253
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004854363LA2100X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008037060Medicaid