Provider Demographics
NPI:1366829335
Name:PACHECO, STEPHANIE MICHELLE (CRNA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:PACHECO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:M
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:7900 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-3055
Mailing Address - Country:US
Mailing Address - Phone:843-449-3381
Mailing Address - Fax:843-449-9721
Practice Address - Street 1:7900 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-3055
Practice Address - Country:US
Practice Address - Phone:843-449-3381
Practice Address - Fax:843-449-9721
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD139850367500000X
SC20055367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered