Healthcare Provider Details

I. General information

NPI: 1568596468
Provider Name (Legal Business Name): JAN H LANDER RN, MN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 TAYLOR STREET SUITE 4 E PALMETTO HEALTH BAPTIST - DIABETES EDUCATION
COLUMBIA SC
29201-2923
US

IV. Provider business mailing address

1333 TAYLOR STREET SUITE 4 E PALMETTO HEALTH BAPTIST - DIABETES EDUCATION
COLUMBIA SC
29201-2923
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-3956
  • Fax: 803-296-8908
Mailing address:
  • Phone: 803-296-3956
  • Fax: 803-296-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number24672
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: