Provider Demographics
NPI:1306875661
Name:CHRISTALDI, PAMELA S (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:S
Last Name:CHRISTALDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:102 GOSSMAN DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-246-4140
Practice Address - Fax:910-695-2192
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC900387363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0954OtherSC MEDICAID PROVIDER#
NCP00020701OtherPALMETTO GBA PROVIDER#
NCFH4000360OtherFIRSTCAROLINACARE PROV.#
NC8300111OtherEVERCARE
NCC6782OtherMEDCOST PROVIDER#
NC7000979Medicaid
NCP00020701OtherPALMETTO GBA PROVIDER#
NCC6782OtherMEDCOST PROVIDER#