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General NPI Number Information
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NPI Number | 1003967860
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Entity Type | Individual
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Provider Name | ELAINE AMELLA APRN
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Gender | Female
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 99 JONATHAN LUCAS ST ROOM 410
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City | CHARLESTON
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State | SC
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Zip | 29425-8900
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Country | US
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Telephone | 843-792-4627
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Fax |
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Provider Business Mailing Address
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Address Line | 1545 LANDINGS RUN
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City | MT PLEASANT
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State | SC
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Zip | 29464-7716
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Country | US
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Telephone | 843-792-4627
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | R 76317
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License Number State | SC
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