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General NPI Number Information
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NPI Number | 1144455601
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Entity Type | Individual
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Provider Name | ELIZABETH MARY HERNICK GNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/27/2009
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | CORPORATE OFFICE 3523 PELHAM RD, SUITE C
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City | GREENVILLE
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State | SC
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Zip | 29615-4191
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Country | US
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Telephone | 864-306-0966
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Fax | 864-306-2544
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Provider Business Mailing Address
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Address Line | P.O. BOX 14611
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City | GREENVILLE
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State | SC
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Zip | 29610-4611
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Country | US
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Telephone | 864-306-0966
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Fax | 864-306-2544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 19157
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | R106798-7
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License Number State | MN
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