Individual
MRS. VICKI LYNN LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
333 REVOLUTIONARY TRL, FAIRFAX, SC 29827-7109
(803) 632-2533
(803) 632-3285
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
(803) 259-3250
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
27377
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27377
MEDICAL LICENSE
SC
05
—
NP9418
—
SC
01
—
SCP955
MEDICARE
SC
Enumeration date
03/19/2013
Last updated
01/11/2024
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