Provider Demographics
NPI:1558952952
Name:ALENA MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:ALENA MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARANDA
Authorized Official - Middle Name:SHAYANNICE
Authorized Official - Last Name:DENDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-205-3167
Mailing Address - Street 1:812 CASTLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:SC
Mailing Address - Zip Code:29334-9820
Mailing Address - Country:US
Mailing Address - Phone:864-205-3167
Mailing Address - Fax:
Practice Address - Street 1:812 CASTLEWOOD LN
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334-9820
Practice Address - Country:US
Practice Address - Phone:864-205-3167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty