Healthcare Provider Details

I. General information

NPI: 1699091298
Provider Name (Legal Business Name): WENDY ABERCROMBIE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PLAZA CIR SUITE J
CLINTON SC
29325-7559
US

IV. Provider business mailing address

500 PLAZA CIR SUITE J
CLINTON SC
29325-7559
US

V. Phone/Fax

Practice location:
  • Phone: 864-938-9690
  • Fax: 864-833-9039
Mailing address:
  • Phone: 864-938-9690
  • Fax: 864-833-9039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3928
License Number StateSC

VIII. Authorized Official

Name: WENDY W ABERCROMBIE
Title or Position: OWNER
Credential: FNP
Phone: 864-938-9690