Provider Demographics
NPI:1861492092
Name:VIGEANT, SUSAN (APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:VIGEANT
Suffix:
Gender:F
Credentials:APRN
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 68
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29731-6068
Mailing Address - Country:US
Mailing Address - Phone:803-327-6103
Mailing Address - Fax:803-328-5443
Practice Address - Street 1:2400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8968
Practice Address - Country:US
Practice Address - Phone:803-327-6103
Practice Address - Fax:803-328-5443
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1561364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ341223859Medicare UPIN