Individual
AMANDA T HALTIWANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
600 N WHEELER AVE, PROSPERITY, SC 29127-8400
(803) 364-4852
(803) 364-2014
Mailing address
PO BOX 630, 600 N WHEELER AVE, PROSPERITY, SC 29127-0630
(803) 364-4852
(803) 364-2014
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APRN3585
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
AA27983093
MEDICARE PTAN
SC
05
—
NP1242
—
SC
Enumeration date
07/02/2008
Last updated
06/25/2009
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