Provider Demographics
NPI:1417904301
Name:MAZZA, PAMELA B (NP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:MAZZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:BRIGHT-CHAMBERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:109 BEE ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-5703
Mailing Address - Country:US
Mailing Address - Phone:843-789-7025
Mailing Address - Fax:843-789-6109
Practice Address - Street 1:109 BEE ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-5703
Practice Address - Country:US
Practice Address - Phone:843-789-7025
Practice Address - Fax:843-789-6109
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN712207R00000X
SC712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00648613OtherRAILROAD MEDICARE #
SCNP0749Medicaid
SCP00648613OtherRAILROAD MEDICARE #
P099245551Medicare PIN
SC1558313080Medicare PIN