Provider Demographics
NPI:1104269133
Name:GERALD, AMY PAIGE (RN)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:PAIGE
Last Name:GERALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 SANDY BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-4215
Mailing Address - Country:US
Mailing Address - Phone:843-464-3760
Mailing Address - Fax:843-464-3763
Practice Address - Street 1:1123 SANDY BLUFF RD
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-4215
Practice Address - Country:US
Practice Address - Phone:843-464-3760
Practice Address - Fax:843-464-3763
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC78365163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse