Provider Demographics
NPI:1770112310
Name:TRAVIS, PAMELA I (LVN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:I
Last Name:TRAVIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7151 WOODLAKE PKWY LOT 251
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3749
Mailing Address - Country:US
Mailing Address - Phone:210-273-2241
Mailing Address - Fax:
Practice Address - Street 1:7151 WOODLAKE PKWY LOT 251
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-3749
Practice Address - Country:US
Practice Address - Phone:210-273-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225621164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse