Healthcare Provider Details

I. General information

NPI: 1366829335
Provider Name (Legal Business Name): STEPHANIE MICHELLE STEWART CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE M PACHECO CRNA

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 N KINGS HWY
MYRTLE BEACH SC
29572-3055
US

IV. Provider business mailing address

7900 N KINGS HWY
MYRTLE BEACH SC
29572-3055
US

V. Phone/Fax

Practice location:
  • Phone: 843-449-3381
  • Fax: 843-449-9721
Mailing address:
  • Phone: 843-449-3381
  • Fax: 843-449-9721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number20055
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD139850
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: