MEDICARE: PAMELA S DELOACH CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	33497	NC

General Provider Information

NPI Number	:	1437100633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA S DELOACH CRNA

Provider Business Mailing Address
First Line	:	2963 FLAT GAP RD
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-8768
Country	:	US
Telephone Number	:	276-782-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	430 RANKIN DR
Second Line	:
City	:	MARION
State	:	NC
Zip	:	28752-6568
Country	:	US
Telephone Number	:	828-659-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	12/16/2016

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Directions to “ PAMELA S DELOACH CRNA” Practice Location

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