Individual
JESSICA BRUBECK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
505 WOODLAND DR, KERSHAW, SC 29067-1704
(843) 680-1342
Mailing address
505 WOODLAND DR, KERSHAW, SC 29067-1704
(843) 680-1342
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
20505
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP4244
—
SC
Enumeration date
11/01/2016
Last updated
09/27/2021
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