Healthcare Provider Details

I. General information

NPI: 1750345542
Provider Name (Legal Business Name): STEPHANIE DAWN GREENWAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 CHURCH ST
CAMDEN SC
29020-3502
US

IV. Provider business mailing address

12 HURDLE CT
LUGOFF SC
29078
US

V. Phone/Fax

Practice location:
  • Phone: 803-920-9060
  • Fax:
Mailing address:
  • Phone: 803-920-9060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number84086
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: