Healthcare Provider Details

I. General information

NPI: 1720963663
Provider Name (Legal Business Name): NUANCE AESTHETICS AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MONCKTON BLVD
COLUMBIA SC
29206-4710
US

IV. Provider business mailing address

12 ASHFIELD LN
BLYTHEWOOD SC
29016-9091
US

V. Phone/Fax

Practice location:
  • Phone: 843-251-2435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY HAZELRIGG
Title or Position: CO-OWNDER
Credential: NP
Phone: 843-251-2435