Provider Demographics
NPI:1154495331
Name:MCGILVRA, SUSAN L (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:MCGILVRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FLAT ROCK RD
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-5006
Mailing Address - Country:US
Mailing Address - Phone:864-638-0199
Mailing Address - Fax:
Practice Address - Street 1:15579 WELLS HIGHWAY
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4318
Practice Address - Country:US
Practice Address - Phone:864-882-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN153363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics