Provider Demographics
NPI:1316020696
Name:DRAKE, PAMELA W (RN)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:W
Last Name:DRAKE
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:PO BOX 627
Mailing Address - Street 2:
Mailing Address - City:MILLEN
Mailing Address - State:GA
Mailing Address - Zip Code:30442-0627
Mailing Address - Country:US
Mailing Address - Phone:478-982-2811
Mailing Address - Fax:478-982-1589
Practice Address - Street 1:709 VIRGINIA AVE.
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442
Practice Address - Country:US
Practice Address - Phone:478-982-2811
Practice Address - Fax:478-982-1589
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN070137163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator