MEDICARE: YOUNG WOMEN NETWORK

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	251B00000X	Case Management Agency
2	174H00000X	Health Educator

General Provider Information

NPI Number	:	1548606072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG WOMEN NETWORK

Provider Business Mailing Address
First Line	:	3262 LANDMARK DR
Second Line	:	SUITE 102
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8576
Country	:	US
Telephone Number	:	843-901-8712
Fax Number	:

Provider Business Practice Location Address
First Line	:	3262 LANDMARK DR
Second Line	:	SUITE 102
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29418-8576
Country	:	US
Telephone Number	:	843-901-8712
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. EVON V WIGFALL
Credential	:
Telephone Number	:	843-901-8712

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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Directions to “YOUNG WOMEN NETWORK ” Practice Location

Language	Start Address	Practice Location

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