Healthcare Provider Details

I. General information

NPI: 1679482749
Provider Name (Legal Business Name): ABBY EMERICK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 AVEBURY LN
COLUMBIA SC
29229-8143
US

IV. Provider business mailing address

104 AVEBURY LN
COLUMBIA SC
29229-8143
US

V. Phone/Fax

Practice location:
  • Phone: 704-674-8820
  • Fax:
Mailing address:
  • Phone: 704-674-8820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number263905
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: