Provider Demographics
NPI:1366433294
Name:MYERS, SUSAN ELLEN (WHNPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELLEN
Last Name:MYERS
Suffix:
Gender:F
Credentials:WHNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 DIAMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9464
Mailing Address - Country:US
Mailing Address - Phone:843-849-8523
Mailing Address - Fax:
Practice Address - Street 1:3 CHARLESTON CENTER DR
Practice Address - Street 2:CHARLESTON COUNTY HEALTH CLINIC
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1162
Practice Address - Country:US
Practice Address - Phone:843-579-4606
Practice Address - Fax:843-570-4621
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN 620363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC16Medicaid