Provider Demographics
NPI:1437827193
Name:CRISP, PAMELA L (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:CRISP
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 DUNCAN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BOWMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29018-9051
Mailing Address - Country:US
Mailing Address - Phone:803-682-0501
Mailing Address - Fax:
Practice Address - Street 1:2641 DUNCAN CHAPEL RD
Practice Address - Street 2:
Practice Address - City:BOWMAN
Practice Address - State:SC
Practice Address - Zip Code:29018-9051
Practice Address - Country:US
Practice Address - Phone:803-682-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC88501251J00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No251J00000XAgenciesNursing Care