Basic Information
| Provider Information | |||||||||
| NPI: | 1316476625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUKE | ||||||||
| FirstName: | BERTINA | ||||||||
| MiddleName: | LYNETTE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 GREAT NORTH RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292235149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2566518860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2611 LIBERTY HILL RD | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290201871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034325323 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2017 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 2-051953 | AL | N | Nursing Service Providers | Licensed Vocational Nurse | 163W00000X | 220611 | SC | Y | Nursing Service Providers | Registered Nurse |
No ID Information.