Individual
FANTASIA KIMMIAH PEREIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 DEWEY AVE, SPARTANBURG, SC 29303-3009
(864) 585-0366
Mailing address
250 DEWEY AVE, SPARTANBURG, SC 29303-3009
(864) 585-0366
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
52767
SC
Other
Enumeration date
05/18/2022
Last updated
05/18/2022
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