Individual
SANDRA LA ROCQUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1303 38TH AVE N, MYRTLE BEACH, SC 29577-1315
(843) 445-1697
Mailing address
1303 38TH AVE N, MYRTLE BEACH, SC 29577-1315
(843) 445-1697
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
26787A
SC
363LF0000X
Family Nurse Practitioner
5004067
NC
Other
Enumeration date
08/21/2008
Last updated
12/20/2022
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