Healthcare Provider Details

I. General information

NPI: 1457405169
Provider Name (Legal Business Name): DONNA N. ATENCIO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 MARION ST
COLUMBIA SC
29201-2113
US

IV. Provider business mailing address

129 TAMWOOD LN
ELGIN SC
29045-8726
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-4130
  • Fax: 803-253-4090
Mailing address:
  • Phone: 803-898-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number59804
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: