Doctor Name: | MS. HOLLY GWALTNEY |
NPI Number: | 1871526335 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 5401724 |
Business Practice Address: | 450 North St Bamberg, SC - 290031377 |
Business Phone Number: | 8032455168 |
Business Fax Number: | 8032456275 |
Mailing Address: | 450 North St, BAMBERG |
State: | SC |
Postal Code: | 290031377 |
Phone Number: | 8032455168 |
Fax Number: | 8032456275 |
NPI Enumeration Date: | 07/08/2006 |
NPI Last Update Date: | 07/28/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5401724 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |