Healthcare Provider Details

I. General information

NPI: 1053767327
Provider Name (Legal Business Name): JENNIFER SANDERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 05/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E CHEVES ST
FLORENCE SC
29506-2526
US

IV. Provider business mailing address

1701 MALDEN DR
FLORENCE SC
29505-3127
US

V. Phone/Fax

Practice location:
  • Phone: 843-615-8234
  • Fax:
Mailing address:
  • Phone: 843-615-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number107388
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: