Provider Demographics
NPI:1578802856
Name:HANZLIK, KIM TAYLOR (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:TAYLOR
Last Name:HANZLIK
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 1:2621 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8035
Mailing Address - Country:US
Mailing Address - Phone:803-699-2981
Mailing Address - Fax:803-699-2971
Practice Address - Street 1:2621 CLEMSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8035
Practice Address - Country:US
Practice Address - Phone:803-699-2981
Practice Address - Fax:803-699-2971
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38637163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool