Individual
SHANA BENNETTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2320 N HIGHWAY 41A, MARION, SC 29571-6481
(843) 423-8345
Mailing address
1212 RAIN DROP CT, MARION, SC 29571-7782
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P37932
SC
Other
Enumeration date
09/11/2014
Last updated
09/11/2014
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