Individual
LACEY RENEA HANTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
133 E 1ST NORTH ST STE 5, SUMMERVILLE, SC 29483-6873
(843) 872-1592
Mailing address
133 E 1ST NORTH ST STE 5, SUMMERVILLE, SC 29483-6873
(843) 872-1592
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
1178328
TX
363LF0000X
Family Nurse Practitioner
Primary
29706
SC
Other
Enumeration date
11/15/2024
Last updated
12/12/2024
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