MEDICARE: ELISSA REILLY SLATER BSN RN

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	163WS0121X	Plastic Surgery Registered Nurse	280649	SC

General Provider Information

NPI Number	:	1467243931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISSA REILLY SLATER BSN RN

Provider Business Mailing Address
First Line	:	2838 TRADEWIND DR
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7983
Country	:	US
Telephone Number	:	424-413-3244
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 PALM BLVD STE 2D
Second Line	:
City	:	ISLE OF PALMS
State	:	SC
Zip	:	29451-2165
Country	:	US
Telephone Number	:	424-413-3244
Fax Number	:

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

Provider Enumeration Date	:	05/14/2025
Last Update Date	:	05/14/2025

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