Healthcare Provider Details

I. General information

NPI: 1235540899
Provider Name (Legal Business Name): MARILYNN ANNE BIRCHMORE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2014
Last Update Date: 05/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MCGEE RD
ANDERSON SC
29625-2104
US

IV. Provider business mailing address

2215 WESTMINSTER HWY
WALHALLA SC
29691-5023
US

V. Phone/Fax

Practice location:
  • Phone: 864-716-3863
  • Fax: 864-716-3619
Mailing address:
  • Phone: 864-716-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95608
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: