Healthcare Provider Details

I. General information

NPI: 1588000657
Provider Name (Legal Business Name): JENNIFER MOORE LAMB RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NORTH ACADEMY ST BUILDING K
KINGSTREE SC
29556
US

IV. Provider business mailing address

500 N ACADEMY ST BUILDING K
KINGSTREE SC
29556-3408
US

V. Phone/Fax

Practice location:
  • Phone: 843-355-5571
  • Fax: 843-355-6297
Mailing address:
  • Phone: 843-355-5571
  • Fax: 843-355-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number68017
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: