Healthcare Provider Details

I. General information

NPI: 1841229630
Provider Name (Legal Business Name): NANCY C PENDRY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BROAD ST
SUMTER SC
29150-4102
US

IV. Provider business mailing address

4416 FOREST DR 2ND FLOOR
COLUMBIA SC
29206-3104
US

V. Phone/Fax

Practice location:
  • Phone: 803-778-6555
  • Fax: 803-773-8226
Mailing address:
  • Phone: 803-782-4278
  • Fax: 803-782-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number968
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: