Healthcare Provider Details

I. General information

NPI: 1861837833
Provider Name (Legal Business Name): MARY P BEBENSEE RN, BSN, NCSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1565 RIFLE RANGE RD
MOUNT PLEASANT SC
29464-3935
US

IV. Provider business mailing address

1565 RIFLE RANGE RD
MOUNT PLEASANT SC
29464-3935
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-2838
  • Fax: 843-849-2884
Mailing address:
  • Phone: 843-849-2838
  • Fax: 843-849-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26227
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: