Individual
MARY LOU KORPON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
202 BENTONS LODGE RD, SUMMERVILLE, SC 29485-6322
(843) 871-2588
(843) 871-1664
Mailing address
202 BENTONS LODGE RD, SUMMERVILLE, SC 29485-6322
(843) 871-2588
(843) 871-1664
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
APN486
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP0187
—
SC
Enumeration date
01/16/2006
Last updated
03/27/2017
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