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DEMETRICE NICHOLE GIST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
1324 COMMERCE DR, DILLON, SC 29536
(843) 774-3851
(843) 774-2622
Mailing address
PO BOX 929, DILLON, SC 29536
(843) 774-3351
(843) 774-2622

Taxonomy

Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
91850
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
405127
SC
Enumeration date
08/31/2006
Last updated
07/08/2007
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