Healthcare Provider Details

I. General information

NPI: 1093946550
Provider Name (Legal Business Name): GWENDOLYN GEDDIES RN., C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 HUNGRYNECK BLVD SUITE C-364
MOUNT PLEASANT SC
29464-3484
US

IV. Provider business mailing address

1150 HUNGRYNECK BLVD SUITE C-364
MOUNT PLEASANT SC
29464-3484
US

V. Phone/Fax

Practice location:
  • Phone: 843-388-9990
  • Fax: 843-388-0349
Mailing address:
  • Phone: 843-388-9990
  • Fax: 843-388-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number712032
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: