1194014340 NPI number — MS. RHODA MAE ASCANIO APRN, FNP-BC

Table of content: MS. RHODA MAE ASCANIO APRN, FNP-BC (NPI 1194014340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194014340 NPI number — MS. RHODA MAE ASCANIO APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ASCANIO
Provider First Name:
RHODA
Provider Middle Name:
MAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-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:
1194014340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 PRESIDENT ST., SUITE 410 SOUTH
Provider Second Line Business Mailing Address:
MSC 861
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-792-5421
Provider Business Mailing Address Fax Number:
843-792-5432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 PRESIDENT ST STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29425-5712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-792-5421
Provider Business Practice Location Address Fax Number:
843-792-5432
Provider Enumeration Date:
03/28/2011

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: 363LF0000X , with the licence number:  3445 , 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: NP1806 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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