Individual
SHUNTI CHICK JETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2111 WILSON RD, NEWBERRY, SC 29108-1603
(803) 321-2170
Mailing address
2111 WILSON RD, NEWBERRY, SC 29108-1603
(803) 321-2170
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P24740
SC
Other
Enumeration date
04/05/2019
Last updated
04/05/2019
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