Individual
JADE HAZEL PACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
107 SUNSET DR, MANNING, SC 29102-2904
(803) 435-4447
Mailing address
1615 ZOAR CHURCH RD, SUMTER, SC 29153-9180
(803) 464-8697
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
263902
SC
363LF0000X
Family Nurse Practitioner
Primary
29972
SC
Other
Enumeration date
12/10/2024
Last updated
04/03/2025
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