Healthcare Provider Details

I. General information

NPI: 1356053052
Provider Name (Legal Business Name): DIANA DENNISON ENTERPRISE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 HIGHMARKET STREET
GEORGETOWN SC
29440
US

IV. Provider business mailing address

5460 HIGHMARKET STREET
GEORGETOWN SC
29440
US

V. Phone/Fax

Practice location:
  • Phone: 843-304-7566
  • Fax:
Mailing address:
  • Phone: 843-304-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANA DENNISON
Title or Position: CEO/OWNER OF BUSINESS
Credential: CNA/MED-TECH
Phone: 843-304-7566