Healthcare Provider Details

I. General information

NPI: 1710183363
Provider Name (Legal Business Name): MYRTLE ANNE STAPLES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 IRON BRIDGE DR SUITE 100
MT PLEASANT SC
29466-7401
US

IV. Provider business mailing address

1189 IRON BRIDGE DR SUITE 100
MT PLEASANT SC
29466-7401
US

V. Phone/Fax

Practice location:
  • Phone: 843-856-1210
  • Fax: 843-856-1189
Mailing address:
  • Phone: 843-856-1210
  • Fax: 843-856-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number355
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: