Doctor Name: | WANDA W GRAINGER |
NPI Number: | 1073684577 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 1033 |
Business Practice Address: | 3109 Casey St Suite A Loris, SC - 295692807 |
Business Phone Number: | 8437569292 |
Business Fax Number: | 8437569260 |
Mailing Address: | Po Box 3239, FLORENCE |
State: | SC |
Postal Code: | 295023239 |
Phone Number: | 8433929222 |
Fax Number: | 8433921445 |
NPI Enumeration Date: | 11/13/2006 |
NPI Last Update Date: | 10/30/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 1033 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |