Provider Demographics
NPI:1164423695
Name:WILCHANOVSKY, MARY ELISHEVA (APRN, WHNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELISHEVA
Last Name:WILCHANOVSKY
Suffix:
Gender:F
Credentials:APRN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ARLINGTON DR
Mailing Address - Street 2:A-3
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5010
Mailing Address - Country:US
Mailing Address - Phone:843-571-1123
Mailing Address - Fax:
Practice Address - Street 1:4050 BRIDGE VIEW DR
Practice Address - Street 2:SUITE 600
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7488
Practice Address - Country:US
Practice Address - Phone:843-746-3800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCWH 870363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCWH 870OtherAPRN LICENSE NUMBER