Healthcare Provider Details

I. General information

NPI: 1760720262
Provider Name (Legal Business Name): MELINDA DENE SYRING-NEMITZ REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 APPLE VALLEY RD
DUNCAN SC
29334-9402
US

IV. Provider business mailing address

114 APPLE VALLEY RD
DUNCAN SC
29334-9402
US

V. Phone/Fax

Practice location:
  • Phone: 864-205-9768
  • Fax: 864-577-7629
Mailing address:
  • Phone: 864-205-9768
  • Fax: 864-577-7629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number97196
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: