MEDICARE: MS. MYRTLE ANNE STAPLES APRN

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
1	163WW0101X	Ambulatory Women's Health Care Registered Nurse	355	SC

General Provider Information

NPI Number	:	1710183363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MYRTLE ANNE STAPLES APRN

Provider Business Mailing Address
First Line	:	1189 IRON BRIDGE DR
Second Line	:	SUITE 100
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7401
Country	:	US
Telephone Number	:	843-856-1210
Fax Number	:	843-856-1189

Provider Business Practice Location Address
First Line	:	1189 IRON BRIDGE DR
Second Line	:	SUITE 100
City	:	MT PLEASANT
State	:	SC
Zip	:	29466-7401
Country	:	US
Telephone Number	:	843-856-1210
Fax Number	:	843-856-1189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	07/08/2007

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