Healthcare Provider Details

I. General information

NPI: 1174931380
Provider Name (Legal Business Name): LANI N HENDRIX APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 COMMONWEALTH DR STE 120
GREENVILLE SC
29615-4881
US

IV. Provider business mailing address

135 COMMONWEALTH DR STE 120
GREENVILLE SC
29615-4881
US

V. Phone/Fax

Practice location:
  • Phone: 864-675-4600
  • Fax: 513-952-6002
Mailing address:
  • Phone: 888-696-3541
  • Fax: 513-952-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18981
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: