Provider Demographics
NPI:1073085965
Name:GONSHOR, STEPHANIE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:GONSHOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 421718
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:SC
Mailing Address - Zip Code:29442-4203
Mailing Address - Country:US
Mailing Address - Phone:843-652-8226
Mailing Address - Fax:843-652-8032
Practice Address - Street 1:2347 S HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-7611
Practice Address - Country:US
Practice Address - Phone:843-357-2443
Practice Address - Fax:843-357-2132
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2021-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC22336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC22336OtherSC STATE LICENSE