MEDICARE: MARY ELIZABETH DURANT WHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	4156	SC
2	363LW0102X	Women's Health Nurse Practitioner	40279	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4156	OTHER	SC	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285741249
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH DURANT WHNP

Provider Business Mailing Address
First Line	:	1264 RIBAUT RD
Second Line	:	BUILDING 200
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6123
Country	:	US
Telephone Number	:	843-524-5455
Fax Number	:	843-524-5655

Provider Business Practice Location Address
First Line	:	1264 RIBAUT RD
Second Line	:	BUILDING 200
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6123
Country	:	US
Telephone Number	:	843-824-5455
Fax Number	:	843-524-5655

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	03/10/2020

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