Individual
HEATHER D MANIGAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSES AIDE
Contact information
Practice address
806 AUGUSTINE ST, LAKE CITY, SC 29560-4102
(843) 550-7110
Mailing address
806 AUGUSTINE ST, LAKE CITY, SC 29560-4102
(843) 550-7110
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
167658
SC
Other
Enumeration date
12/04/2020
Last updated
12/04/2020
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