Individual
MISS SHAVONTE NICOLE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHLEBOTOMIST, MOBILE
Contact information
Practice address
221 FORE RD, FLORENCE, SC 29506-4520
(843) 409-3638
Mailing address
221 FORE RD, FLORENCE, SC 29506-4520
(843) 409-3638
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
9989149
SC
Other
Enumeration date
12/14/2022
Last updated
12/14/2022
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