Basic Information
| Provider Information | |||||||||
| NPI: | 1518471192 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAXWELL | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANN | ||||||||
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| OtherLastName: | SINGLETARY | ||||||||
| OtherFirstName: | MELISSA | ||||||||
| OtherMiddleName: | ANN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1507 EAGLE LANDING BLVD | ||||||||
| Address2: | |||||||||
| City: | HANAHAN | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294108583 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433302960 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4600 GOER DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294066500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435541029 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2017 | ||||||||
| LastUpdateDate: | 10/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 224494 | SC | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363LF0000X | 21770 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.