Healthcare Provider Details

I. General information

NPI: 1346453065
Provider Name (Legal Business Name): PAMELA LYNN ELIASON APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST CSB 903
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

577 TRAVELERS BLVD
SUMMERVILLE SC
29485-8220
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-2123
  • Fax: 843-792-0644
Mailing address:
  • Phone: 843-875-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number218
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: