MEDICARE: ELIZABETH J. REPEDE NP

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
1	363LF0000X	Family Nurse Practitioner	812	SC
2	363LF0000X	Family Nurse Practitioner	5004384	NC

General Provider Information

NPI Number	:	1275596306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH J. REPEDE NP

Provider Business Mailing Address
First Line	:	7075 HARBOR CT
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-8534
Country	:	US
Telephone Number	:	802-517-0302
Fax Number	:	803-802-3420

Provider Business Practice Location Address
First Line	:	7075 HARBOR CT
Second Line	:
City	:	TEGA CAY
State	:	SC
Zip	:	29708-8534
Country	:	US
Telephone Number	:	802-517-0302
Fax Number	:	803-802-3420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	05/20/2009

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