1396787669 NPI number — RENEE I. L'ECUYER APRN-BC

Table of content: RENEE I. L'ECUYER APRN-BC (NPI 1396787669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396787669 NPI number — RENEE I. L'ECUYER APRN-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
L'ECUYER
Provider First Name:
RENEE
Provider Middle Name:
I.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396787669
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2117 GERVAIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29204-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-748-1181
Provider Business Mailing Address Fax Number:
803-748-1185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2117 GERVAIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29204-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-748-1181
Provider Business Practice Location Address Fax Number:
803-748-1185
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F1243 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: 1243 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP0479 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".