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General NPI Number Information
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NPI Number | 1144276569
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Entity Type | Individual
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Provider Name | PAM AMANDA LOCKE CRNA
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 606 BLACK RIVER RD
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City | GEORGETOWN
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State | SC
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Zip | 29440-3304
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Country | US
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Telephone | 843-240-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 217 LUMBEE CIR
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-4391
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Country | US
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Telephone | 438-240-8047
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R72682
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License Number State | SC
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