Healthcare Provider Details

I. General information

NPI: 1689363772
Provider Name (Legal Business Name): JILLIAN MARIE PRICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MEETING ST
LANCASTER SC
29720-2202
US

IV. Provider business mailing address

150 BEE ST APT 715
CHARLESTON SC
29401-5707
US

V. Phone/Fax

Practice location:
  • Phone: 802-286-1214
  • Fax:
Mailing address:
  • Phone: 609-417-5624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number253913
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number143111
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number27406
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: