Provider Demographics
NPI:1215181151
Name:MCSORLEY, JEANNINE BELLANTI (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNINE
Middle Name:BELLANTI
Last Name:MCSORLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:932 N LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-2151
Mailing Address - Country:US
Mailing Address - Phone:803-957-5322
Mailing Address - Fax:803-957-4123
Practice Address - Street 1:932 N LAKE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2151
Practice Address - Country:US
Practice Address - Phone:803-957-5322
Practice Address - Fax:803-957-4123
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA33879090Medicare PIN