Individual
JENNI LISA HACKENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1709 OLD TROLLEY RD, SUMMERVILLE, SC 29485-8276
(843) 873-2225
Mailing address
621 VAN BUREN DR, SUMMERVILLE, SC 29486-0405
(803) 522-4570
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
25116
SC
Other
Enumeration date
06/30/2021
Last updated
06/30/2021
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