Provider Demographics
NPI:1740298918
Name:MCNITZKY, PAMELA ANNE (NNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:ANNE
Last Name:MCNITZKY
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WOLFETON WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-6034
Mailing Address - Country:US
Mailing Address - Phone:210-826-1439
Mailing Address - Fax:
Practice Address - Street 1:1221 NORTH MOPAC EXPRESSWAY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78708
Practice Address - Country:US
Practice Address - Phone:512-901-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX456833363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX96179901Medicaid
TX18218001OtherMEDICAID/THSTEPS
TX096179907Medicaid
TX096179908OtherCSHCN
TX96179901Medicaid
TX096179907Medicaid