Basic Information
| Provider Information | |||||||||
| NPI: | 1285773846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVI | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | DEMITRA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6069 | ||||||||
| Address2: | |||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291716069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 935 W 2ND ST | ||||||||
| Address2: | |||||||||
| City: | SWANSEA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291608665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035682000 | ||||||||
| FaxNumber: | 8034684190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2007 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN 1217 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1217 | 01 | SC | LICENSE | OTHER |