Provider Demographics
NPI:1235128141
Name:HALLMAN, SUSAN ANNETTE WEST (RNC GONP)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:ANNETTE WEST
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:RNC GONP
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:ANNETTE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNC GONP
Mailing Address - Street 1:471 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6389
Mailing Address - Country:US
Mailing Address - Phone:803-641-2840
Mailing Address - Fax:803-641-2858
Practice Address - Street 1:471 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6389
Practice Address - Country:US
Practice Address - Phone:803-641-2840
Practice Address - Fax:803-641-2858
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17974363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
50BBDGHMedicare ID - Type Unspecified