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NPI Code Detail

MEDICARE: AQUILLA BEC

MEDICARE: AQUILLA BEC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse PractitionerAPN2510SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134233810
Entity Type Code : Individual
Provider Name (Legal Business Name) : AQUILLA BEC
Provider Business Mailing Address
First Line : 1268 S 4TH ST
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-0703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1268 S 4TH ST
Second Line :
City : HARTSVILLE
State : SC
Zip : 29550-0703
Country : US
Telephone Number : 843-332-0118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 09/01/2017

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Directions to “ AQUILLA BEC ” Practice Location

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