Provider Demographics
NPI:1275596306
Name:REPEDE, ELIZABETH J (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:J
Last Name:REPEDE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7075 HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:TEGA CAY
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8534
Mailing Address - Country:US
Mailing Address - Phone:802-517-0302
Mailing Address - Fax:803-802-3420
Practice Address - Street 1:7075 HARBOR CT
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-8534
Practice Address - Country:US
Practice Address - Phone:802-517-0302
Practice Address - Fax:803-802-3420
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC812363LF0000X
NC5004384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCR40813Medicare UPIN
SCR408138398Medicare PIN
SCR408138397Medicare PIN