Healthcare Provider Details

I. General information

NPI: 1457717761
Provider Name (Legal Business Name): GERTRUDE BASSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PELHAM RD
GREENVILLE SC
29615-3300
US

IV. Provider business mailing address

800 PELHAM RD
GREENVILLE SC
29615-3300
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-5800
  • Fax: 864-234-5888
Mailing address:
  • Phone: 864-234-5800
  • Fax: 864-234-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19915
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: