Provider Demographics
NPI:1568427540
Name:ABBOTT, CONNIE D (ARNP BC)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:D
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:ARNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 638
Mailing Address - Street 2:DUE WEST FAMILY MEDICINE
Mailing Address - City:DUE WEST
Mailing Address - State:SC
Mailing Address - Zip Code:29639
Mailing Address - Country:US
Mailing Address - Phone:864-379-2345
Mailing Address - Fax:864-379-3228
Practice Address - Street 1:6 COLLEGE STREET
Practice Address - Street 2:DUE WEST FAMILY MEDICINE
Practice Address - City:DUE WEST
Practice Address - State:SC
Practice Address - Zip Code:29639
Practice Address - Country:US
Practice Address - Phone:864-379-2345
Practice Address - Fax:864-379-3228
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9193902363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4964ZMedicare ID - Type Unspecified
Q46058Medicare UPIN