Healthcare Provider Details

I. General information

NPI: 1992499545
Provider Name (Legal Business Name): SEKEYA WHITE SPECIMEN COLLECTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 BUSH RIVER RD SUITE217 #197
COLUMBIA SC
29210
US

IV. Provider business mailing address

652 BUSH RIVER RD SUITE 217 #197
COLUMBIA SC
29210
US

V. Phone/Fax

Practice location:
  • Phone: 800-876-1541
  • Fax:
Mailing address:
  • Phone: 800-876-1541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: