Healthcare Provider Details

I. General information

NPI: 1346353950
Provider Name (Legal Business Name): JANINE REECE WRECSICS RN,BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 DEVINE ST
COLUMBIA SC
29208-0001
US

IV. Provider business mailing address

245 BRAEWICK RD
COLUMBIA SC
29212-8209
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-3658
  • Fax: 803-777-0126
Mailing address:
  • Phone: 803-777-3658
  • Fax: 803-777-0126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number39765
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: