Provider Demographics
NPI:1588000657
Name:LAMB, JENNIFER MOORE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MOORE
Last Name:LAMB
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N ACADEMY ST
Mailing Address - Street 2:BUILDING K
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3408
Mailing Address - Country:US
Mailing Address - Phone:843-355-5571
Mailing Address - Fax:843-355-6297
Practice Address - Street 1:500 NORTH ACADEMY ST
Practice Address - Street 2:BUILDING K
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556
Practice Address - Country:US
Practice Address - Phone:843-355-5571
Practice Address - Fax:843-355-6297
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC68017163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool