Healthcare Provider Details

I. General information

NPI: 1861615676
Provider Name (Legal Business Name): JESSICA SUE MENDELSOHN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
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 TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00187000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3017047
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1816682
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26778
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: