Provider Demographics
NPI:1881072072
Name:NELSMITH WOUND CARE GROUP
Entity type:Organization
Organization Name:NELSMITH WOUND CARE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:843-509-1684
Mailing Address - Street 1:PO BOX 1807
Mailing Address - Street 2:263 MAYFIELD DRIVE
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-1807
Mailing Address - Country:US
Mailing Address - Phone:843-509-1684
Mailing Address - Fax:
Practice Address - Street 1:263 MAYFIELD DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-7320
Practice Address - Country:US
Practice Address - Phone:843-509-1684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-08
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109341163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty