Provider Demographics
NPI:1245444702
Name:DOLE, PAMELA J (EDD, MPH, FNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:DOLE
Suffix:
Gender:F
Credentials:EDD, MPH, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W THAMES ST BLDG 301
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-7155
Mailing Address - Country:US
Mailing Address - Phone:860-859-4720
Mailing Address - Fax:860-859-4700
Practice Address - Street 1:401 W THAMES ST BLDG 301
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-7155
Practice Address - Country:US
Practice Address - Phone:860-859-4720
Practice Address - Fax:860-859-4700
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001995363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner