Healthcare Provider Details

I. General information

NPI: 1720748668
Provider Name (Legal Business Name): RENEW YOURSELF HEALTH AND BEAUTY BAR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 OXPENS RD
WARRENVILLE SC
29851-3295
US

IV. Provider business mailing address

1467 OXPENS RD
WARRENVILLE SC
29851-3295
US

V. Phone/Fax

Practice location:
  • Phone: 803-645-2489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMIKA GLOVER
Title or Position: OWNER
Credential:
Phone: 803-645-2489