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General NPI Number Information
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NPI Number | 1982092847
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Entity Type | Individual
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Provider Name | NATASHA BLACK
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Gender | Female
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 407 BOONE HILL RD
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City | SUMMERVILLE
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State | SC
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Zip | 29483-3501
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Country | US
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Telephone | 843-592-9145
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Fax |
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Provider Business Mailing Address
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Address Line | 73 MESSENGER LN
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City | KINGSTREE
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State | SC
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Zip | 29556-5576
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Country | US
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Telephone | 843-592-9145
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | P34076
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License Number State | SC
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