Healthcare Provider Details

I. General information

NPI: 1013881069
Provider Name (Legal Business Name): ERIN MUCKENFUSS LAROCHE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2769 CHERRY POINT RD
WADMALAW ISLAND SC
29487-7007
US

IV. Provider business mailing address

2769 CHERRY POINT RD
WADMALAW ISLAND SC
29487-7007
US

V. Phone/Fax

Practice location:
  • Phone: 843-478-6584
  • Fax:
Mailing address:
  • Phone: 843-478-6584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number81412
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: