Provider Demographics
NPI:1700449964
Name:JENNINGS, NICOLE D (HAIR LOSS SPECIALIST)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:D
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TROTTER CT
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-8734
Mailing Address - Country:US
Mailing Address - Phone:803-312-4850
Mailing Address - Fax:
Practice Address - Street 1:920 SAINT ANDREWS RD STE 2&3
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5816
Practice Address - Country:US
Practice Address - Phone:803-312-4850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist