Provider Demographics
NPI:1285741249
Name:DURANT, MARY ELIZABETH (WHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:DURANT
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 RIBAUT RD
Mailing Address - Street 2:BUILDING 200
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6123
Mailing Address - Country:US
Mailing Address - Phone:843-524-5455
Mailing Address - Fax:843-524-5655
Practice Address - Street 1:1264 RIBAUT RD
Practice Address - Street 2:BUILDING 200
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6123
Practice Address - Country:US
Practice Address - Phone:843-824-5455
Practice Address - Fax:843-524-5655
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4156367A00000X
WV40279363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4156OtherSTATE LICENSE
WV7101240000Medicaid
WV7101240000Medicaid
SC4156OtherSTATE LICENSE