Provider Demographics
NPI:1710218532
Name:RAVAN, GEORGINA URSULA (FNP)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:URSULA
Last Name:RAVAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 UNIVERSITY WAY
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303
Mailing Address - Country:US
Mailing Address - Phone:864-503-5191
Mailing Address - Fax:864-503-0754
Practice Address - Street 1:800 UNIVERSITY WAY
Practice Address - Street 2:USC-UPSTATE HEALTH SERVICES
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-503-5191
Practice Address - Fax:864-503-0754
Is Sole Proprietor?:No
Enumeration Date:2010-01-18
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA61559485Medicare PIN