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General NPI Number Information
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NPI Number | 1275903676
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Entity Type | Individual
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Provider Name | JENNIFER DAWN WADDELL HIS
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Gender | Female
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Dates
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Enumeration Date | 09/29/2015
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Last Update Date | 09/29/2015
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Provider Practice Location Address
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Address Line | 857 NE MAIN ST
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-2041
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Country | US
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Telephone | 864-881-1663
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Fax | 864-751-7524
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Provider Business Mailing Address
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Address Line | PO BOX 80623
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City | SIMPSONVILLE
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State | SC
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Zip | 29680-0011
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Country | US
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Telephone | 864-881-1663
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Fax | 864-751-7524
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | HAS-0524
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License Number State | SC
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