Individual
KURISHIA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
121 MONROE ST, ANDERSON, SC 29624-1409
(864) 353-3753
Mailing address
121 MONROE ST, ANDERSON, SC 29624-1409
(864) 353-3753
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
52273
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199029762
DHEC
SC
Enumeration date
11/04/2020
Last updated
11/04/2020
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