MEDICARE: MAMIE DUCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	004399	SC
2	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	044139	OTHER		NURSE LICENSED
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3014415	OTHER	SC	WE KARE HOME CARE AGENCY

General Provider Information

NPI Number	:	1104474238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMIE DUCK

Provider Business Mailing Address
First Line	:	207A N WASHINGTON ST
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4204
Country	:	US
Telephone Number	:	803-316-4571
Fax Number	:	803-938-5443

Provider Business Practice Location Address
First Line	:	207A N WASHINGTON ST
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29150-4204
Country	:	US
Telephone Number	:	803-938-5898
Fax Number	:	803-938-5443

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2019
Last Update Date	:	10/13/2022

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Directions to “ MAMIE DUCK ” Practice Location

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