Basic Information
| Provider Information | |||||||||
| NPI: | 1770569485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SISSON | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 97 BARNES RD | ||||||||
| Address2: | STE 2 PYRAMID PRIMARY CARE PHYSICIANS PC | ||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032650355 | ||||||||
| FaxNumber: | 2032657413 | ||||||||
| Practice Location | |||||||||
| Address1: | 97 BARNES RD | ||||||||
| Address2: | STE 2 PYRAMID PRIMARY CARE PHYSICIANS PC | ||||||||
| City: | WALLINGFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 064921885 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032650355 | ||||||||
| FaxNumber: | 2032657413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2005 | ||||||||
| LastUpdateDate: | 03/05/2012 | ||||||||
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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 | 364S00000X | 001911 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 363LF0000X | 001911 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.