Individual
MS. MARY REGINA DORTENZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN-ANP
Contact information
Practice address
176 MCSWAIN DR, WEST COLUMBIA, SC 29169-4825
(803) 767-4465
(803) 767-4120
Mailing address
176 MCSWAIN DR, WEST COLUMBIA, SC 29169-4825
(803) 767-4465
(803) 767-4120
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
4097
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP1564
—
SC
Enumeration date
02/14/2008
Last updated
02/10/2025
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