Individual
JULIE C SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
200 BROAD STREET, MULLINS, SC 29574
(843) 464-3740
Mailing address
200 BROAD ST, MULLINS, SC 29574-2532
(843) 464-3740
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P39017
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P39017
—
SC
Enumeration date
04/10/2013
Last updated
04/10/2013
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