Healthcare Provider Details

I. General information

NPI: 1689690364
Provider Name (Legal Business Name): RAMONA BOULWARD COPELAND R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2715 COLONIAL DR
COLUMBIA SC
29203-6818
US

IV. Provider business mailing address

105 LEONARD DR
LEXINGTON SC
29072-9305
US

V. Phone/Fax

Practice location:
  • Phone: 803-898-4859
  • Fax: 803-898-4899
Mailing address:
  • Phone: 803-957-6957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number18568
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: