Healthcare Provider Details

I. General information

NPI: 1255589313
Provider Name (Legal Business Name): TRUDY LOVEJOY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHAPMAN HILL RD
CLEMSON SC
29631
US

IV. Provider business mailing address

1 INDEPENDENCE PT STE 212
GREENVILLE SC
29615-4536
US

V. Phone/Fax

Practice location:
  • Phone: 864-653-4071
  • Fax:
Mailing address:
  • Phone: 864-797-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3617
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3617
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: