Individual
MRS. LAURA H TENBRUNSEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCD
Contact information
Practice address
146 N HOSPITAL DR, SUITE 120, WEST COLUMBIA, SC 29169-4800
(803) 936-7530
(803) 936-7532
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
3434
SC
231H00000X
Audiologist
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GP4644
MEDICAID GROUP NUMBER
SC
01
—
Q349201305
MEDICARE PTAN
SC
05
—
SA0762
—
SC
Enumeration date
07/28/2006
Last updated
11/11/2020
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