1568427540 NPI number — MRS. CONNIE D ABBOTT ARNP BC

Table of content: MRS. CONNIE D ABBOTT ARNP BC (NPI 1568427540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568427540 NPI number — MRS. CONNIE D ABBOTT ARNP BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABBOTT
Provider First Name:
CONNIE
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP 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:
1568427540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 638
Provider Second Line Business Mailing Address:
DUE WEST FAMILY MEDICINE
Provider Business Mailing Address City Name:
DUE WEST
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-379-2345
Provider Business Mailing Address Fax Number:
864-379-3228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 COLLEGE STREET
Provider Second Line Business Practice Location Address:
DUE WEST FAMILY MEDICINE
Provider Business Practice Location Address City Name:
DUE WEST
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-379-2345
Provider Business Practice Location Address Fax Number:
864-379-3228
Provider Enumeration Date:
04/20/2006

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: 363L00000X , with the licence number:  ARNP 9193902 , 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)