Healthcare Provider Details

I. General information

NPI: 1508693250
Provider Name (Legal Business Name): DELANEY NICOLE DEHERTOGH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL DR STE 270
MOUNT PLEASANT SC
29464-3244
US

IV. Provider business mailing address

6036 CURRAN ST
MURRELLS INLET SC
29576-7453
US

V. Phone/Fax

Practice location:
  • Phone: 578-155-3596
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number29371
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29371
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: