1891128310 NPI number — MS. GLORIA JEAN BELL LICENSE NURSE

Table of content: MS. GLORIA JEAN BELL LICENSE NURSE (NPI 1891128310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891128310 NPI number — MS. GLORIA JEAN BELL LICENSE NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELL
Provider First Name:
GLORIA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LICENSE NURSE
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:
1891128310
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2715 COLONIAL DR
Provider Second Line Business Mailing Address:
SUITE 200B
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29203-6818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-898-8888
Provider Business Mailing Address Fax Number:
803-898-0837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2715 COLONIAL DR
Provider Second Line Business Practice Location Address:
SUITE 200B
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29203-6818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-898-8888
Provider Business Practice Location Address Fax Number:
803-898-0837
Provider Enumeration Date:
08/20/2013

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: 164W00000X , with the licence number:  P38930 , 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)





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