Provider Demographics
NPI:1043265945
Name:FLECKENSTEIN, PAMELA MORRIS (MSN, CRNP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MORRIS
Last Name:FLECKENSTEIN
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30668 SUSSEX HWY
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-4421
Mailing Address - Country:US
Mailing Address - Phone:302-875-6550
Mailing Address - Fax:302-875-3130
Practice Address - Street 1:30668 SUSSEX HWY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956-4421
Practice Address - Country:US
Practice Address - Phone:302-875-6550
Practice Address - Fax:302-875-3130
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO71586363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161211501Medicaid
PENDINGMedicare ID - Type Unspecified
MD161211501Medicaid