1235128141 NPI number — MRS. SUSAN ANNETTE WEST HALLMAN RNC GONP

Table of content: MRS. SUSAN ANNETTE WEST HALLMAN RNC GONP (NPI 1235128141)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235128141 NPI number — MRS. SUSAN ANNETTE WEST HALLMAN RNC GONP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALLMAN
Provider First Name:
SUSAN
Provider Middle Name:
ANNETTE WEST
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNC GONP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEST
Provider Other First Name:
SUSAN
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNC GONP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1235128141
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
471 UNIVERSITY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29801-6389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-641-2840
Provider Business Mailing Address Fax Number:
803-641-2858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
471 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801-6389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-641-2840
Provider Business Practice Location Address Fax Number:
803-641-2858
Provider Enumeration Date:
10/14/2005

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: 363LX0001X , with the licence number:  17974 , 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)