Provider Demographics
NPI:1083048219
Name:PAPPAS, LOIS GLENNETTE (RN)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:GLENNETTE
Last Name:PAPPAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 OLD TAMAH RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9000
Mailing Address - Country:US
Mailing Address - Phone:803-476-4809
Mailing Address - Fax:803-476-4820
Practice Address - Street 1:1528 OLD TAMAH RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9000
Practice Address - Country:US
Practice Address - Phone:803-476-4809
Practice Address - Fax:803-476-4820
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40688163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool