Provider Demographics
NPI:1598394892
Name:JETER, LAWANA M
Entity Type:Individual
Prefix:
First Name:LAWANA
Middle Name:M
Last Name:JETER
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 1:8 SYCAMORE DR STE B8B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2965
Mailing Address - Country:US
Mailing Address - Phone:864-535-1825
Mailing Address - Fax:864-729-8224
Practice Address - Street 1:8 SYCAMORE DR STE B8B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2965
Practice Address - Country:US
Practice Address - Phone:864-535-1825
Practice Address - Fax:864-729-8224
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC97501163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health