Provider Demographics
NPI:1770569485
Name:SISSON, PAMELA M (APRN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:SISSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 BARNES RD
Mailing Address - Street 2:STE 2 PYRAMID PRIMARY CARE PHYSICIANS PC
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1885
Mailing Address - Country:US
Mailing Address - Phone:203-265-0355
Mailing Address - Fax:203-265-7413
Practice Address - Street 1:97 BARNES RD
Practice Address - Street 2:STE 2 PYRAMID PRIMARY CARE PHYSICIANS PC
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1885
Practice Address - Country:US
Practice Address - Phone:203-265-0355
Practice Address - Fax:203-265-7413
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001911364S00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P09194Medicare UPIN
CT500001515Medicare ID - Type Unspecified