MEDICARE: MRS. VIVIEN STEMBRIDGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1740553007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VIVIEN STEMBRIDGE

Provider Business Mailing Address
First Line	:	1836 LAKE CAROLINA DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7013
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1836 LAKE CAROLINA DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7013
Country	:	US
Telephone Number	:	803-873-2039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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