1811937352 NPI number — SUSAN L WEBSTER CRNA

Table of content: DR. GAIL DENISE FANCHER D.O. (NPI 1386610509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811937352 NPI number — SUSAN L WEBSTER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEBSTER
Provider First Name:
SUSAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUDSON
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811937352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 HEATHER FALLS LN
Provider Second Line Business Mailing Address:
HEATHER FALLS LANE
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29681-4694
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-216-1983
Provider Business Mailing Address Fax Number:
864-216-1983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 GROVE RD
Provider Second Line Business Practice Location Address:
2ND FLOOR ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29605-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-455-7111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2006

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: 367500000X , with the licence number:  APRN2896 , 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: PEND , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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