Healthcare Provider Details

I. General information

NPI: 1518471192
Provider Name (Legal Business Name): MELISSA ANN MAXWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA ANN SINGLETARY

II. Dates (important events)

Enumeration Date: 11/19/2017
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 GOER DR STE 201
NORTH CHARLESTON SC
29406-6500
US

IV. Provider business mailing address

1507 EAGLE LANDING BLVD
HANAHAN SC
29410-8583
US

V. Phone/Fax

Practice location:
  • Phone: 843-554-1029
  • Fax:
Mailing address:
  • Phone: 843-330-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number224494
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21770
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: