Provider Demographics
NPI:1770695843
Name:GAU, PAMELA (APRN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:112 QUARRY RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-4816
Mailing Address - Country:US
Mailing Address - Phone:203-372-4065
Mailing Address - Fax:203-372-1644
Practice Address - Street 1:112 QUARRY RD
Practice Address - Street 2:SUITE 120
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-4816
Practice Address - Country:US
Practice Address - Phone:203-372-4065
Practice Address - Fax:203-372-1644
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0000962363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004183430Medicaid
CTP18619Medicare UPIN
CT500000551Medicare ID - Type Unspecified