Healthcare Provider Details

I. General information

NPI: 1154509016
Provider Name (Legal Business Name): SANDRA DIANE WASKOWSKI APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2008
Last Update Date: 02/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 TIGER BLVD
CLEMSON SC
29631-1480
US

IV. Provider business mailing address

PO BOX 293
CLEMSON SC
29633-0293
US

V. Phone/Fax

Practice location:
  • Phone: 864-654-6800
  • Fax:
Mailing address:
  • Phone: 864-886-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number803
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: