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NPI Code Detail

MEDICARE: STEPHANIE MARIE GONSHOR NP

MEDICARE: STEPHANIE MARIE GONSHOR NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner22336SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
122336OTHERSCSC STATE LICENSE

General Provider Information

NPI Number : 1073085965
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MARIE GONSHOR NP
Provider Business Mailing Address
First Line : PO BOX 421718
Second Line :
City : GEORGETOWN
State : SC
Zip : 29442-4203
Country : US
Telephone Number : 843-652-8226
Fax Number : 843-652-8032
Provider Business Practice Location Address
First Line : 2347 S HIGHWAY 17
Second Line :
City : MURRELLS INLET
State : SC
Zip : 29576-7611
Country : US
Telephone Number : 843-357-2443
Fax Number : 843-357-2132
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/18/2018
Last Update Date : 03/16/2021

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