Healthcare Provider Details

I. General information

NPI: 1528047073
Provider Name (Legal Business Name): MARIE BELK FADELEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF SOUTH CAROLINA THOMSON STUDENT HEALTH CENTER WCC
COLUMBIA SC
29208-0001
US

IV. Provider business mailing address

3301 OVERCREEK RD
COLUMBIA SC
29206-5145
US

V. Phone/Fax

Practice location:
  • Phone: 803-777-6816
  • Fax: 803-777-9063
Mailing address:
  • Phone: 803-777-6819
  • Fax: 803-777-9063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN 522
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: