Healthcare Provider Details

I. General information

NPI: 1376132688
Provider Name (Legal Business Name): SHARI STEPHENS WIMBERLY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 CAROLINA AVE
ORANGEBURG SC
29115-4944
US

IV. Provider business mailing address

162 SKE BO DR
REEVESVILLE SC
29471-4110
US

V. Phone/Fax

Practice location:
  • Phone: 803-533-5480
  • Fax:
Mailing address:
  • Phone: 843-560-0773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53761
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: