Healthcare Provider Details

I. General information

NPI: 1023214855
Provider Name (Legal Business Name): PAMELA ANN SWAIM-MEJIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MAIN ST
DANVILLE IL
61832-5100
US

IV. Provider business mailing address

113 E LAWRIN BLVD
TERRE HAUTE IN
47803-3007
US

V. Phone/Fax

Practice location:
  • Phone: 217-554-3186
  • Fax:
Mailing address:
  • Phone: 812-299-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000424A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: