Provider Demographics
NPI:1245773134
Name:RISH, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 BROAD RIVER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2358
Mailing Address - Country:US
Mailing Address - Phone:803-749-8585
Mailing Address - Fax:803-749-8909
Practice Address - Street 1:7921 BROAD RIVER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2358
Practice Address - Country:US
Practice Address - Phone:803-749-8585
Practice Address - Fax:803-749-8909
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other