Doctor Name: | CONNIE MAE LENAGH |
NPI Number: | 1265771984 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP-C |
License Number: | 18136 |
Business Practice Address: | 924 E. Butler Rd Mauldin, SC - 29662 |
Business Phone Number: | 8642341282 |
Business Fax Number: | |
Mailing Address: | 14 S Penobscot Ct, SIMPSONVILLE |
State: | SC |
Postal Code: | 296814315 |
Phone Number: | 8642883308 |
Fax Number: | |
NPI Enumeration Date: | 02/01/2013 |
NPI Last Update Date: | 02/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 18136 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |