1285899146 NPI number — MRS. ELIZABETH ANN VANDEVELDE ANP-C

Table of content: MRS. ELIZABETH ANN VANDEVELDE ANP-C (NPI 1285899146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285899146 NPI number — MRS. ELIZABETH ANN VANDEVELDE ANP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANDEVELDE
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-C
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:
1285899146
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
535 BATTY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMTER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29154-8156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-607-9070
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
129 NORTH WASHINGTON
Provider Second Line Business Practice Location Address:
TUOMEY HEALTHCARE SYSTEM
Provider Business Practice Location Address City Name:
SUMTER
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-774-5248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2008

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: 363LA2200X , with the licence number:  APRN9413942 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54-04286 . This is a "SC DHEC" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: A0796043 . This is a "AMERICAN ACADEMY OF NURSE PRACTITIONERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4286 . This is a "SC LLR" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".