Individual
JERRI NICOLE MASANOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
171B MONROE LN, LEXINGTON, SC 29072-3904
(803) 358-8496
(866) 614-3887
Mailing address
1209 LOWNSDALE RD, WEST COLUMBIA, SC 29170-3178
(803) 920-6376
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
22146
SC
Other
Enumeration date
08/15/2018
Last updated
11/19/2021
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