Provider Demographics
NPI:1376963553
Name:ZACHARY, ELAINE (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:
Last Name:ZACHARY
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2688 FORESTBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7956
Mailing Address - Country:US
Mailing Address - Phone:843-236-0185
Mailing Address - Fax:
Practice Address - Street 1:800 21ST AVE N
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-7424
Practice Address - Country:US
Practice Address - Phone:843-448-8407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39435163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health