Healthcare Provider Details

I. General information

NPI: 1649513243
Provider Name (Legal Business Name): MRS. FIONA NATALIE GBEHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 PALAMINO LN
ELGIN SC
29045-2001
US

IV. Provider business mailing address

1025 PALAMINO LN
ELGIN SC
29045-2001
US

V. Phone/Fax

Practice location:
  • Phone: 719-244-4676
  • Fax:
Mailing address:
  • Phone: 719-244-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1618469
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: