Provider Demographics
NPI:1720173172
Name:BEVAN, DEANNA FIEGEL (MSN, RN, FNPC)
Entity Type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:FIEGEL
Last Name:BEVAN
Suffix:
Gender:F
Credentials:MSN, RN, FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:448 FOUNTAIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5717
Mailing Address - Country:US
Mailing Address - Phone:803-783-2777
Mailing Address - Fax:
Practice Address - Street 1:SUMTER COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:105 NORTH MAGNOLIA ST
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-773-5511
Practice Address - Fax:803-773-6366
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF 74363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0538Medicaid