Healthcare Provider Details

I. General information

NPI: 1396988309
Provider Name (Legal Business Name): MARY J DINAPOLI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 GREAT EGRET DR
JOHNS ISLAND SC
29455-9026
US

IV. Provider business mailing address

3205 GREAT EGRET DR
JOHNS ISLAND SC
29455-9026
US

V. Phone/Fax

Practice location:
  • Phone: 843-955-0492
  • Fax:
Mailing address:
  • Phone: 843-955-0492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPN27314
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NJ00192600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: