Individual
DEDRA HARLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 PINE HVN, BARNWELL, SC 29812-2820
(803) 686-2169
(803) 259-3843
Mailing address
111 PINE HVN, BARNWELL, SC 29812-2820
(803) 686-2169
(803) 259-3843
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONES
NONE
SC
Enumeration date
12/09/2019
Last updated
12/09/2019
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