Provider Demographics
NPI:1356931927
Name:LANFORD, HAILEY NICOLE (NP)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:NICOLE
Last Name:LANFORD
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 1:300 JOHN ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1463
Mailing Address - Country:US
Mailing Address - Phone:864-334-7727
Mailing Address - Fax:864-555-7300
Practice Address - Street 1:300 JOHN ST STE 4B
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1463
Practice Address - Country:US
Practice Address - Phone:864-334-7727
Practice Address - Fax:864-555-7300
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC23409OtherSTATE LICENSES