Healthcare Provider Details

I. General information

NPI: 1205717048
Provider Name (Legal Business Name): MARLENA DAWN KUCINSKI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MALLARD LAKES DR
LEXINGTON SC
29072-7674
US

IV. Provider business mailing address

700 MALLARD LAKES DR
LEXINGTON SC
29072-7674
US

V. Phone/Fax

Practice location:
  • Phone: 803-530-1065
  • Fax:
Mailing address:
  • Phone: 803-530-1065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30948
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: