Healthcare Provider Details

I. General information

NPI: 1760246672
Provider Name (Legal Business Name): WENDY ELIZABETH HOLCOMBE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 GREENE ST
COLUMBIA SC
29208-4001
US

IV. Provider business mailing address

1601 GREENE ST
COLUMBIA SC
29208-4001
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-7412
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5020860
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberGAA-NP002526
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29016
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: