Healthcare Provider Details

I. General information

NPI: 1497060586
Provider Name (Legal Business Name): GERILYN SAMPSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 W PALMETTO ST STE 5
FLORENCE SC
29501-4909
US

IV. Provider business mailing address

913 W PALMETTO ST
FLORENCE SC
29501-4352
US

V. Phone/Fax

Practice location:
  • Phone: 513-280-0667
  • Fax:
Mailing address:
  • Phone: 513-280-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number238313
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: