Individual
LYNNE CAROL GOUDLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
265 PEELER RD, GASTON, SC 29053-8730
(803) 955-3320
Mailing address
265 PEELER RD, GASTON, SC 29053-8730
(803) 955-3320
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PR32978
SC
Other
Enumeration date
08/13/2006
Last updated
07/08/2007
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