Healthcare Provider Details

I. General information

NPI: 1861725251
Provider Name (Legal Business Name): ANGELA MICHELLE GASKINS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 PINEY HEIGHTS RD
WARRENVILLE SC
29851-2707
US

IV. Provider business mailing address

370 PINEY HEIGHTS RD
WARRENVILLE SC
29851-2707
US

V. Phone/Fax

Practice location:
  • Phone: 803-645-4150
  • Fax: 803-593-3381
Mailing address:
  • Phone: 803-645-4150
  • Fax: 803-593-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberP27542
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberP27542
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: