Healthcare Provider Details

I. General information

NPI: 1609338441
Provider Name (Legal Business Name): ELEANOR ELISE BJERKEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 HIGHWAY 9 E
LITTLE RIVER SC
29566-7833
US

IV. Provider business mailing address

3980 HIGHWAY 9 E STE 220
LITTLE RIVER SC
29566-8164
US

V. Phone/Fax

Practice location:
  • Phone: 433-999-7748
  • Fax:
Mailing address:
  • Phone: 433-999-7748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number91480
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: