Provider Demographics
NPI:1932776077
Name:PRIESTER, DELLARESE LEE
Entity type:Individual
Prefix:MRS
First Name:DELLARESE
Middle Name:LEE
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DELLARESE
Other - Middle Name:LEE
Other - Last Name:HERBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:122 DRAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-8285
Mailing Address - Country:US
Mailing Address - Phone:404-791-6931
Mailing Address - Fax:
Practice Address - Street 1:6437 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:800-827-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202891163WM0705X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical