Provider Demographics
NPI:1518328418
Name:FENELON, MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:
Last Name:FENELON
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 1:10053 HIGHLAND CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7700
Mailing Address - Country:US
Mailing Address - Phone:704-904-3367
Mailing Address - Fax:
Practice Address - Street 1:2670 MILLS PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8599
Practice Address - Country:US
Practice Address - Phone:803-985-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-19
Last Update Date:2016-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily