Individual
MRS. PHYLLIS W DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
1931 INDUSTRIAL PARK RD, CONWAY, SC 29526-5482
(843) 504-1084
Mailing address
1931 INDUSTRIAL PARK RD, CONWAY, SC 29526-5482
(843) 504-1084
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
R28290
SC
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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