Individual
JENNIFER RUTH PALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
87 SPRINGVIEW LANE, SUMMERVILLE, SC 29485
(843) 876-7979
Mailing address
PO BOX 602108, CHARLOTTE, NC 28260-2108
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2610
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0905
—
SC
01
—
P00953705
RAIL ROAD MEDICARE
SC
Enumeration date
08/31/2006
Last updated
04/20/2016
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