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General NPI Number Information
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NPI Number | 1265771984
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Entity Type | Individual
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Provider Name | CONNIE MAE LENAGH NP-C
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Gender | Female
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Dates
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Enumeration Date | 02/01/2013
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 924 E. BUTLER RD
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City | MAULDIN
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State | SC
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Zip | 29662
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Country | US
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Telephone | 864-234-1282
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Fax |
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Provider Business Mailing Address
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Address Line | 14 S PENOBSCOT CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4315
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Country | US
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Telephone | 864-288-3308
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 18136
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License Number State | SC
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