1730426073 NPI number — MS. HAZELINE CLAUDIA OUTRAM-EVANS

Table of content: MS. HAZELINE CLAUDIA OUTRAM-EVANS (NPI 1730426073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730426073 NPI number — MS. HAZELINE CLAUDIA OUTRAM-EVANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OUTRAM-EVANS
Provider First Name:
HAZELINE
Provider Middle Name:
CLAUDIA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OUTRAMWEEKES
Provider Other First Name:
HAZELINE
Provider Other Middle Name:
CLAUDIA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN,ANP,PNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730426073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29564-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-615-7320
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 OAK HILL LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREELEYVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29056-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-615-7320
Provider Business Practice Location Address Fax Number:
843-408-0308
Provider Enumeration Date:
01/07/2013

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: 163W00000X , with the licence number:  207924 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: 396113-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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