Healthcare Provider Details

I. General information

NPI: 1558810358
Provider Name (Legal Business Name): JENNIFER WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 BRIARWOOD RD
LANCASTER SC
29720-1802
US

IV. Provider business mailing address

530 BRIARWOOD RD
LANCASTER SC
29720-1802
US

V. Phone/Fax

Practice location:
  • Phone: 803-320-3157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number68628
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: