Healthcare Provider Details

I. General information

NPI: 1407335151
Provider Name (Legal Business Name): JUDY WOOLCOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S PARK CIR STE 101
CHARLESTON SC
29407-4625
US

IV. Provider business mailing address

1 S PARK CIR STE 101
CHARLESTON SC
29407-4625
US

V. Phone/Fax

Practice location:
  • Phone: 843-953-1261
  • Fax: 843-953-1276
Mailing address:
  • Phone: 843-953-1261
  • Fax: 843-953-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN231459R
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: