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General NPI Number Information
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NPI Number | 1366547507
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Entity Type | Individual
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Provider Name | DONNELL RAMSEY MACE FNP
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 800 25TH AVE S STE 12
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-4320
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Country | US
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Telephone | 843-256-6721
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Fax | 843-900-2200
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Provider Business Mailing Address
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Address Line | 503 20TH AVE N UNIT 27D
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City | NORTH MYRTLE BEACH
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State | SC
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Zip | 29582-2383
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Country | US
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Telephone | 828-403-5907
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 005001277
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 132174
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 25840
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License Number State | SC
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