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Individual

THOMASENA SARAHDETTA WALLER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
701 GROVE RD, GREENVILLE, SC 29605-4210
(864) 455-7000
Mailing address
102 LAUREL VIEW LN, GREENVILLE, SC 29607-4740

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
00049712
SC

Other

Enumeration date
09/23/2013
Last updated
09/23/2013
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