Individual
MS. AMY R WIELKOPOLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMBT
Contact information
Practice address
4370 CREPE MYRTLE CT UNIT A, MURRELLS INLET, SC 29576-4307
(843) 504-2905
(000) 000-0000
Mailing address
4370 CREPE MYRTLE CT UNIT A, MURRELLS INLET, SC 29576-4307
(843) 504-2905
(000) 000-0000
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
3663
SC
Other
Enumeration date
12/20/2006
Last updated
07/08/2007
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