Basic Information
| Provider Information | |||||||||
| NPI: | 1043265945 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLECKENSTEIN | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | MORRIS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSN, CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30668 SUSSEX HWY | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199564421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028756550 | ||||||||
| FaxNumber: | 3028753130 | ||||||||
| Practice Location | |||||||||
| Address1: | 30668 SUSSEX HWY | ||||||||
| Address2: | |||||||||
| City: | LAUREL | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199564421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028756550 | ||||||||
| FaxNumber: | 3028753130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | RO71586 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 161211501 | 05 | MD | MEDICAID |