Individual
MRS. JENNA DAGGETT BENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
108 HEALTHCARE DR, LANCASTER, SC 29720-8037
(803) 286-9963
Mailing address
PO BOX 603898, CHARLOTTE, NC 28260-3898
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0010-02317
NC
363AS0400X
Surgical Physician Assistant
0010-02317
NC
363AS0400X
Surgical Physician Assistant
Primary
2026
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1045PA
—
SC
Enumeration date
07/06/2010
Last updated
01/25/2021
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