Individual
AMANDA L WARDLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 935-8292
Mailing address
300 E MCBEE AVE, GREENVILLE, SC 29601-2842
(864) 522-8603
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2638
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN1412
—
SC
Enumeration date
04/21/2006
Last updated
02/08/2022
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