Individual
ALEXANDER PETKOVSEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
920 DOUG WHITE DR STE 210, MYRTLE BEACH, SC 29572-4181
(843) 497-6348
(843) 497-6351
Mailing address
920 DOUG WHITE DR STE 210, MYRTLE BEACH, SC 29572-4181
(843) 497-6348
(843) 497-6351
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20710
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12
—
SC
Enumeration date
02/07/2017
Last updated
01/27/2022
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