Healthcare Provider Details

I. General information

NPI: 1023444767
Provider Name (Legal Business Name): MARY RYAN MELIN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

IV. Provider business mailing address

2073 CHARLIE HALL BLVD
CHARLESTON SC
29414-5834
US

V. Phone/Fax

Practice location:
  • Phone: 843-571-0643
  • Fax: 843-571-0311
Mailing address:
  • Phone: 843-571-0643
  • Fax: 843-571-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18486
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: