Individual
MARIGRACE VANDEVENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
(843) 234-5037
(843) 347-1541
Mailing address
300 SINGLETON RIDGE RD, CONWAY, SC 29526-9142
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
226954
SC
Other
Enumeration date
07/20/2017
Last updated
07/20/2017
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