Provider Demographics
NPI:1063064848
Name:MOSS, PAMELA SULLIVAN (APRN-CNS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SULLIVAN
Last Name:MOSS
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 ORLEANS STREET
Mailing Address - Street 2:SHEIKH ZAYED TOWER, 10 WEST, ROOM 10023
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-955-8137
Mailing Address - Fax:
Practice Address - Street 1:1800 ORLEANS STREET
Practice Address - Street 2:SHEIKH ZAYED TOWER, 10 WEST, ROOM 10023
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:410-955-8137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCS00175364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care