MEDICARE: SUSAN ADKINS STABENE FNP

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	363LF0000X	Family Nurse Practitioner	3615	SC

General Provider Information

NPI Number	:	1992061840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ADKINS STABENE FNP

Provider Business Mailing Address
First Line	:	20 22ND AVE
Second Line	:
City	:	ISLE OF PALMS
State	:	SC
Zip	:	29451-2381
Country	:	US
Telephone Number	:	843-408-7263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1676 N HIGHWAY 17
Second Line	:
City	:	MOUNT PLEASANT
State	:	SC
Zip	:	29464-3310
Country	:	US
Telephone Number	:	843-408-7263
Fax Number	:

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

Provider Enumeration Date	:	04/04/2012
Last Update Date	:	04/04/2012

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