Basic Information
| Provider Information | |||||||||
| NPI: | 1437556875 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANNIBAL | ||||||||
| FirstName: | LIZZIE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1245 | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291161245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033954497 | ||||||||
| FaxNumber: | 8033952237 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 SAINT MATTHEWS RD | ||||||||
| Address2: | |||||||||
| City: | ORANGEBURG | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291181442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033952200 | ||||||||
| FaxNumber: | 8033952237 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2014 | ||||||||
| LastUpdateDate: | 01/21/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 64789 | SC | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.