Provider Demographics
NPI:1235100017
Name:NECHODOM, OONAGH (NP)
Entity type:Individual
Prefix:MRS
First Name:OONAGH
Middle Name:
Last Name:NECHODOM
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:864-650-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:398 THE PKWY
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4569
Practice Address - Country:US
Practice Address - Phone:864-877-9577
Practice Address - Fax:864-877-9073
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF45339363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC197099OtherMEDCOST
SCNP0992Medicaid
SCAA46556121Medicare PIN
SCC61223Medicare UPIN
SCNP0992Medicaid
SCP00348992Medicare PIN
SC197099OtherMEDCOST
SCP072655121Medicare PIN