MEDICARE: MRS. LAVERNE MURDAUGH APRN

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	363LW0102X	Women's Health Nurse Practitioner	APN2231	SC

General Provider Information

NPI Number	:	1750376943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAVERNE MURDAUGH APRN

Provider Business Mailing Address
First Line	:	500 N MAIN ST
Second Line	:	SUITE 9
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-832-0041
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N MAIN ST
Second Line	:	SUITE 9
City	:	SUMMERVILLE
State	:	SC
Zip	:	29483-6439
Country	:	US
Telephone Number	:	843-832-0041
Fax Number	:

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

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/08/2007

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