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PASEO SHATELLE DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
2200 S IRBY ST, FLORENCE, SC 29505-3423
(843) 662-9945
Mailing address
2200 S IRBY ST, FLORENCE, SC 29505-3423
(843) 662-9945

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
23045
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23045
SC LICENSING BOARD
SC
Enumeration date
07/15/2019
Last updated
09/23/2022
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