Healthcare Provider Details

I. General information

NPI: 1235549494
Provider Name (Legal Business Name): JANICE BURCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MCGEE RD
ANDERSON SC
29625-2104
US

IV. Provider business mailing address

220 MCGEE RD
ANDERSON SC
29625-2104
US

V. Phone/Fax

Practice location:
  • Phone: 864-260-5665
  • Fax:
Mailing address:
  • Phone: 864-260-5665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number32776
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: