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General NPI Number Information
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NPI Number | 1730507120
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Entity Type | Individual
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Provider Name | STACIE WALLING RN
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Gender | Female
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 04/02/2014
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Provider Practice Location Address
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Address Line | 932 HOLLY ST
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City | HOLLY HILL
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State | SC
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Zip | 29059-2762
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Country | US
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Telephone | 803-496-3324
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Fax | 803-496-9653
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Provider Business Mailing Address
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Address Line | 8423 OLD STATE ROAD
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City | HOLLY HILL
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State | SC
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Zip | 29059
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Country | US
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Telephone | 803-496-3324
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Fax | 803-496-9653
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 436478
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License Number State | SC
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