Provider Demographics
NPI:1689963639
Name:LELL, NANCY B CORDOVA
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:B CORDOVA
Last Name:LELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:BALESCA
Other - Last Name:CORDOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1653 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3791
Mailing Address - Country:US
Mailing Address - Phone:888-465-3880
Mailing Address - Fax:
Practice Address - Street 1:1653 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-3791
Practice Address - Country:US
Practice Address - Phone:888-465-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207826163W00000X
SC29911363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse