Individual
KIMBERLY SUZANNE DEMICHELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
721 WAPPOO RD, CHARLESTON, SC 29407-5861
(843) 813-7703
Mailing address
1962 OAK TREE LN, MOUNT PLEASANT, SC 29464-9413
(843) 607-7138
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
44320
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861678534
—
SC
Enumeration date
07/02/2019
Last updated
07/02/2019
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