=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629535836
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIRGINIA LOCHART BAZEN FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2019
-----------------------------------------------------
Last Update Date | 10/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3370 GENERAL WILLIAMS DRIVE
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-702-9392
-----------------------------------------------------
Fax | 866-493-3039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 CASHUA ST
-----------------------------------------------------
City | DARLINGTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29532-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-393-7452
-----------------------------------------------------
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 | APN22586
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------