Healthcare Provider Details

I. General information

NPI: 1578968947
Provider Name (Legal Business Name): MARY PIPPIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 ISLAND FORD RD
NINETY SIX SC
29666-9137
US

IV. Provider business mailing address

2213 ISLAND FORD RD
NINETY SIX SC
29666-9137
US

V. Phone/Fax

Practice location:
  • Phone: 864-942-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number107183
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: