Provider Demographics
NPI:1972672368
Name:KURKUL, PAMELA K (ARNP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:KURKUL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-1608
Mailing Address - Country:US
Mailing Address - Phone:978-821-8630
Mailing Address - Fax:
Practice Address - Street 1:928 RIVERDALE ST
Practice Address - Street 2:
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4620
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN142981363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA142981OtherMASS RNNP
MK0050891OtherDEA CERTIFICATE
MK0050891OtherDEA CERTIFICATE