Provider Demographics
NPI:1003967860
Name:AMELLA, ELAINE (APRN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:AMELLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 LANDINGS RUN
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7716
Mailing Address - Country:US
Mailing Address - Phone:843-792-4627
Mailing Address - Fax:
Practice Address - Street 1:99 JONATHAN LUCAS ST
Practice Address - Street 2:ROOM 410
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8900
Practice Address - Country:US
Practice Address - Phone:843-792-4627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR 76317163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology