Individual
GRAZIELLA COSTA-STEPHENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4724 CHARLOTTE HWY, CLOVER, SC 29710-8095
(803) 831-1911
Mailing address
4724 CHARLOTTE HWY, CLOVER, SC 29710-8095
(803) 831-1911
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21840
SC
363LF0000X
Family Nurse Practitioner
5010366
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21840
SC LICENSE
SC
01
—
5010366
NC LICENSE
NC
Enumeration date
03/30/2018
Last updated
05/03/2022
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