MEDICARE: JEAN T ISHERWOOD WHNP-BC

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	3671	SC

General Provider Information

NPI Number	:	1104812403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN T ISHERWOOD WHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 6069
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29171-6069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 W MAIN ST STE 201&209
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-2507
Country	:	US
Telephone Number	:	803-785-4777
Fax Number	:	803-358-6240

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	06/14/2021

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