Healthcare Provider Details

I. General information

NPI: 1861492092
Provider Name (Legal Business Name): SUSAN VIGEANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W MAIN ST
ROCK HILL SC
29732-8968
US

IV. Provider business mailing address

PO BOX 68
ROCK HILL SC
29731-6068
US

V. Phone/Fax

Practice location:
  • Phone: 803-327-6103
  • Fax: 803-328-5443
Mailing address:
  • Phone: 803-327-6103
  • Fax: 803-328-5443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN1561
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: