Basic Information
| Provider Information | |||||||||
| NPI: | 1952704017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAUST | ||||||||
| FirstName: | LINDA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 309 E 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648596331 | ||||||||
| FaxNumber: | 8648593998 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 E 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648596331 | ||||||||
| FaxNumber: | 8648593998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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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 | 363L00000X | 19122 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 5007201 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | SC50059368 | 01 | SC | MEDICARE NUMBER | OTHER | NP3019 | 05 | SC | MEDICAID |