Healthcare Provider Details

I. General information

NPI: 1093678807
Provider Name (Legal Business Name): SUZANNA MONTES BRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 STATE RD
DILLON SC
29543
US

IV. Provider business mailing address

134 GRICES FERRY CT
MULLINS SC
29574-5999
US

V. Phone/Fax

Practice location:
  • Phone: 843-774-2742
  • Fax: 843-774-2742
Mailing address:
  • Phone: 854-208-3907
  • Fax: 854-208-3907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number52163
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: