Individual
PAMELA GAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
903101
MS
367500000X
Certified Registered Nurse Anesthetist
Primary
R863555
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03010781
—
MS
Enumeration date
10/15/2007
Last updated
08/10/2020
Update your record
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