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General NPI Number Information
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NPI Number | 1467691568
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Entity Type | Organization
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Legal Business Name | PALMETTO TRAVEL MEDICINE
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 2154 N CENTER ST SUITE A-104
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4056
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Country | US
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Telephone | 843-225-5688
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Fax | 843-225-5689
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Provider Business Mailing Address
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Address Line | 2154 N CENTER ST SUITE A-104
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4056
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Country | US
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Telephone | 843-225-5688
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Fax | 843-225-5689
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. INGRID NIELSEN BREWSTER
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Credential | RN
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Telephone | 843-225-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | R98024
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License Number State | SC
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