Healthcare Provider Details

I. General information

NPI: 1780279661
Provider Name (Legal Business Name): MAUREEN LISA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN LISA SCOTT

II. Dates (important events)

Enumeration Date: 03/03/2021
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 38TH AVE N
MYRTLE BEACH SC
29577-1315
US

IV. Provider business mailing address

1303 38TH AVE N
MYRTLE BEACH SC
29577-1315
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24651
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: