Healthcare Provider Details

I. General information

NPI: 1831643675
Provider Name (Legal Business Name): MELISSA JEAN CARDWELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
MONCKS CORNER SC
29461-2673
US

IV. Provider business mailing address

216 CASTLEWOOD CT
HANAHAN SC
29410-4766
US

V. Phone/Fax

Practice location:
  • Phone: 843-719-4600
  • Fax:
Mailing address:
  • Phone: 318-957-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number20272
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number20272
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: