=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518328418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE FENELON NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2016
-----------------------------------------------------
Last Update Date | 03/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1926 INDIA HOOK RD
-----------------------------------------------------
City | ROCK HILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29732-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-904-3367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10053 HIGHLAND CREEK CIR
-----------------------------------------------------
City | FORT MILL
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29707-7700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-904-3367
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 20086
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------