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NPI Code Detail

MEDICARE: BRIANNA LONDONO WEST PA-C

MEDICARE: BRIANNA LONDONO WEST PA-C
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
1363AM0700XMedical Physician Assistant

General Provider Information

NPI Number : 1780417626
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIANNA LONDONO WEST PA-C
Provider Business Mailing Address
First Line : 614 ARNOLD DR
Second Line :
City : BEAUFORT
State : SC
Zip : 29902-4303
Country : US
Telephone Number : 843-263-2141
Fax Number :
Provider Business Practice Location Address
First Line : 1231 RIBAUT RD
Second Line :
City : BEAUFORT
State : SC
Zip : 29902-6147
Country : US
Telephone Number : 843-766-7103
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2024
Last Update Date : 08/26/2024

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Directions to “ BRIANNA LONDONO WEST PA-C” Practice Location

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