Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | RO71586 | MD |
NPI | 1043265945 |
---|---|
Provider Name | Pamela Morris Fleckenstein |
First Address | Laurel, DE 19956-4421 |
Second Address | Laurel, DE 19956-4421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 24/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
161211501 | (05) | MD |
PENDING | (02) |