Healthcare Provider Details

I. General information

NPI: 1881072072
Provider Name (Legal Business Name): NELSMITH WOUND CARE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MAYFIELD DR
GOOSE CREEK SC
29445-7320
US

IV. Provider business mailing address

PO BOX 1807 263 MAYFIELD DRIVE
GOOSE CREEK SC
29445-1807
US

V. Phone/Fax

Practice location:
  • Phone: 843-509-1684
  • Fax:
Mailing address:
  • Phone: 843-509-1684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number109341
License Number StateSC

VIII. Authorized Official

Name: JENNIFER NELSON SMITH
Title or Position: SOLE PROPRIETOR
Credential: BSN RN
Phone: 843-509-1684