Basic Information
| Provider Information | |||||||||
| NPI: | 1649243148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 29 NORTHWEST BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030634068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036892900 | ||||||||
| FaxNumber: | 6038801308 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 NORTHWEST BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030634068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039244680 | ||||||||
| FaxNumber: | 6039243569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2006 | ||||||||
| LastUpdateDate: | 06/19/2012 | ||||||||
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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 | 363LF0000X | 032902-23-03 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 30341280 | 05 | NH | MEDICAID |