Healthcare Provider Details

I. General information

NPI: 1487111415
Provider Name (Legal Business Name): FREDA DENISE ARMSTRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 S LAKE DR STE B
LEXINGTON SC
29073-3701
US

IV. Provider business mailing address

1070 S LAKE DR
LEXINGTON SC
29073-3701
US

V. Phone/Fax

Practice location:
  • Phone: 803-785-6641
  • Fax:
Mailing address:
  • Phone: 803-785-6641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number206750
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: