Healthcare Provider Details

I. General information

NPI: 1598112484
Provider Name (Legal Business Name): LAOLA HUNTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 HUNTING CREEK DR
SIMPSONVILLE SC
29681-5778
US

IV. Provider business mailing address

1 CHICK SPRINGS RD SUITE 101 E
GREENVILLE SC
29609-4946
US

V. Phone/Fax

Practice location:
  • Phone: 864-238-4315
  • Fax: 864-236-5917
Mailing address:
  • Phone: 864-238-4315
  • Fax: 864-236-5917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number64818
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: