Individual
MARY ANN BUCHANAN AGOSTINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
877 W FARIS RD STE D, GREENVILLE, SC 29605-4296
(864) 455-0931
(864) 455-9014
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26712
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
SC
Enumeration date
11/09/2022
Last updated
11/28/2022
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