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Individual

WANDA W GRAINGER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
3109 CASEY ST, SUITE A, LORIS, SC 29569-2807
(843) 756-9292
(843) 756-9260
Mailing address
PO BOX 3239, FLORENCE, SC 29502-3239
(843) 392-9222
(843) 392-1445

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1033
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AA58658552
MEDICARE PTAN
SC
05
NP0792
SC
Enumeration date
11/13/2006
Last updated
02/03/2021
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