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General NPI Number Information
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NPI Number | 1982241956
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Entity Type | Individual
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Provider Name | ANDRILL LAVOUR RICHARD FNP
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Gender | Female
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Dates
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Enumeration Date | 12/09/2019
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 115 ACADEMY AVENUE
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City | GREENWOOD
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State | SC
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Zip | 29646
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Country | US
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Telephone |
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Fax |
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Provider Business Mailing Address
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Address Line | 1198 LEAMAN ST
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City | CROSS HILL
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State | SC
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Zip | 29332-4100
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Country | US
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Telephone | 864-993-6320
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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 | 23399
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 23399
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License Number State | SC
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