1417958513 NPI number — MISS MARIA ELIZABET CARDENAS CNP ANP NP

Table of content: MISS MARIA ELIZABET CARDENAS CNP ANP NP (NPI 1417958513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417958513 NPI number — MISS MARIA ELIZABET CARDENAS CNP ANP NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARDENAS
Provider First Name:
MARIA
Provider Middle Name:
ELIZABET
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNP ANP NP
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:
1417958513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 365
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNS ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29457-0365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-329-6648
Provider Business Mailing Address Fax Number:
803-985-4134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1236 EBENEZER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCK HILL
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29732-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-329-6648
Provider Business Practice Location Address Fax Number:
803-985-4134
Provider Enumeration Date:
08/10/2005

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: 363LG0600X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP0673/GP2323 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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