Individual
THERESA B PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 MEDICAL LN E, WEST COLUMBIA, SC 29169-4813
(803) 936-7679
Mailing address
2720 SUNSET BLVD, ATTN CREDENTIALING, WEST COLUMBIA, SC 29169-4810
(803) 936-7679
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN 1212
SC
Other
Enumeration date
03/09/2007
Last updated
07/08/2007
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