Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | LL84438 | SC |
NPI | 1013532670 |
---|---|
Provider Name | Jenna Hanner Barengo |
First Address | Charleston, SC 29425-8905 |
Second Address | Charleston, SC 29425-8905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2020 |
Last Update Date | 10/06/2020 |