Individual
MARY L MICHAEL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
606 BLACK RIVER RD, GEORGETOWN, SC 29440-3304
(843) 527-7000
(843) 520-8403
Mailing address
PO DRAWER 1718, GEORGETOWN, SC 29442-1718
(843) 527-7000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APN412
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN0272
—
SC
Enumeration date
07/22/2005
Last updated
07/08/2007
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