Healthcare Provider Details

I. General information

NPI: 1285024075
Provider Name (Legal Business Name): HEATHER MARLOWE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2015
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

424 WINDING WAY
COLUMBIA SC
29212-1339
US

V. Phone/Fax

Practice location:
  • Phone: 803-785-6550
  • Fax:
Mailing address:
  • Phone: 803-667-9784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number210803
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: