Individual
AMANDA GERRALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1608 MAIN ST, CONWAY, SC 29526-3572
(843) 248-4700
Mailing address
1608 MAIN ST, CONWAY, SC 29526-3572
(843) 248-4700
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
18893
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP3725
—
SC
Enumeration date
07/22/2014
Last updated
08/20/2024
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