Individual
KAWONNA NICOLE MAPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 JUSTINE CT, CORDOVA, SC 29039-9196
(803) 614-5088
Mailing address
223 MOCKINGBIRD DR, CORDOVA, SC 29039-9641
(803) 662-9587
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
SC
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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