Individual
PAM AMANDA LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
606 BLACK RIVER RD, GEORGETOWN, SC 29440-3304
(843) 240-8047
Mailing address
217 LUMBEE CIR, PAWLEYS ISLAND, SC 29585-4391
(438) 240-8047
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R72682
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1322
—
SC
Enumeration date
05/26/2006
Last updated
11/27/2023
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