Individual
MRS. SUZANNE H DECKELBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8170 ROURK ST STE 100, MYRTLE BEACH, SC 29572-4127
(843) 449-0453
Mailing address
508 DANIA BEACH DR, MYRTLE BEACH, SC 29577-6302
(843) 422-3377
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1714
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1714
SC MEDICAL LICENSE
SC
Enumeration date
06/28/2006
Last updated
10/16/2024
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