Provider Demographics
NPI:1588023444
Name:LICARI, ADRIENNE
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:LICARI
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 1:705 N 8TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2549
Mailing Address - Country:US
Mailing Address - Phone:843-774-2478
Mailing Address - Fax:
Practice Address - Street 1:705 N 8TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2549
Practice Address - Country:US
Practice Address - Phone:843-774-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20000363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care