Provider Demographics
NPI:1699091298
Name:WENDY ABERCROMBIE, LLC
Entity type:Organization
Organization Name:WENDY ABERCROMBIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ABERCROMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:864-938-9690
Mailing Address - Street 1:500 PLAZA CIR
Mailing Address - Street 2:SUITE J
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7559
Mailing Address - Country:US
Mailing Address - Phone:864-938-9690
Mailing Address - Fax:864-833-9039
Practice Address - Street 1:500 PLAZA CIR
Practice Address - Street 2:SUITE J
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-7559
Practice Address - Country:US
Practice Address - Phone:864-938-9690
Practice Address - Fax:864-833-9039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1549Medicaid