Provider Demographics
NPI:1497060586
Name:SAMPSON, GERILYN (RN)
Entity Type:Individual
Prefix:
First Name:GERILYN
Middle Name:
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W PALMETTO ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4352
Mailing Address - Country:US
Mailing Address - Phone:513-280-0667
Mailing Address - Fax:
Practice Address - Street 1:2724 W PALMETTO ST STE 5
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4909
Practice Address - Country:US
Practice Address - Phone:513-280-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC238313163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice