Healthcare Provider Details

I. General information

NPI: 1639505324
Provider Name (Legal Business Name): JENNIFER LUCAS O'BRIANT C.P.M., L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 SHUMPERT RD
WEST COLUMBIA SC
29172-2458
US

IV. Provider business mailing address

146 SHUMPERT ROAD
WEST COLUMBIA SC
29172
US

V. Phone/Fax

Practice location:
  • Phone: 803-341-5554
  • Fax:
Mailing address:
  • Phone: 803-341-5554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLMW-0074
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: