Healthcare Provider Details

I. General information

NPI: 1093200842
Provider Name (Legal Business Name): MRS. LEANNA WILLIS OWINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 MAY RD
SALUDA SC
29138-8441
US

IV. Provider business mailing address

948 MAY RD
SALUDA SC
29138-8441
US

V. Phone/Fax

Practice location:
  • Phone: 864-445-7037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21978
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: