Basic Information
| Provider Information | |||||||||
| NPI: | 1285621102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIVENS | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1225 E GARRISON BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280545115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048657416 | ||||||||
| FaxNumber: | 7048657232 | ||||||||
| Practice Location | |||||||||
| Address1: | 1225 E GARRISON BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280545115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048657416 | ||||||||
| FaxNumber: | 7048657232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2005 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 180 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 180 | 01 | NC | CNM | OTHER | 149875 | 01 | NC | RN LICENSE | OTHER |