=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518058478
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LIGAYA Z AQUINO NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 109 BEE ST
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29401-5703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-577-5011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4464 LORD PROPRIETORS RD
-----------------------------------------------------
City | MEGGETT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29449-6037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-577-5011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WX0200X
-----------------------------------------------------
Taxonomy Name | Oncology Registered Nurse
-----------------------------------------------------
License Number | APN136
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------