Healthcare Provider Details

I. General information

NPI: 1497237481
Provider Name (Legal Business Name): MARYFRANCES STEVENS CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 GREEN LAKE DR
MYRTLE BEACH SC
29572-5509
US

IV. Provider business mailing address

207 GREEN LAKE DR
MYRTLE BEACH SC
29572-5509
US

V. Phone/Fax

Practice location:
  • Phone: 843-945-5108
  • Fax:
Mailing address:
  • Phone: 843-945-5108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: