Healthcare Provider Details

I. General information

NPI: 1942579347
Provider Name (Legal Business Name): ANGELA HEBERT HAYDEN NP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2011
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400-4 COLLEGE AVE SUITE 3
CLEMSON SC
29631-2925
US

IV. Provider business mailing address

PO BOX 909
CENTRAL SC
29630-0909
US

V. Phone/Fax

Practice location:
  • Phone: 864-986-2370
  • Fax:
Mailing address:
  • Phone: 704-640-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number3859
License Number StateSC

VIII. Authorized Official

Name: MS. ANGELA HEBERT HAYDEN
Title or Position: NP
Credential: APRN
Phone: 704-640-8101