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General NPI Number Information
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NPI Number | 1447009121
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Entity Type | Individual
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Provider Name | MONICA DEL SOCORRO FAJARDO-INCER
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Gender | Female
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Dates
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Enumeration Date | 05/15/2024
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 48 CENTENNIAL WAY
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City | GREENVILLE
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State | SC
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Zip | 29605-4662
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Country | US
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Telephone | 864-522-8000
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Fax | 864-522-8005
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8603
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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 | 26725
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License Number State | SC
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