Provider Demographics
NPI:1932686425
Name:SMITH, PAMELA C (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:C
Last Name:SMITH
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 250
Mailing Address - Street 2:
Mailing Address - City:MARSHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28103-0250
Mailing Address - Country:US
Mailing Address - Phone:704-305-7851
Mailing Address - Fax:704-831-5349
Practice Address - Street 1:502 N ELM ST
Practice Address - Street 2:
Practice Address - City:MARSHVILLE
Practice Address - State:NC
Practice Address - Zip Code:28103-1029
Practice Address - Country:US
Practice Address - Phone:704-305-7851
Practice Address - Fax:704-831-5349
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC128655163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse