Healthcare Provider Details

I. General information

NPI: 1154388064
Provider Name (Legal Business Name): NANCY ROSE LEMBO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

763 TRAVELERS BLVD SUITE D
SUMMERVILLE SC
29485-8796
US

IV. Provider business mailing address

763 TRAVELERS BLVD SUITE D
SUMMERVILLE SC
29485
US

V. Phone/Fax

Practice location:
  • Phone: 843-569-5421
  • Fax: 843-569-5973
Mailing address:
  • Phone: 843-569-5421
  • Fax: 843-569-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number918
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: