Provider Demographics
NPI:1437175908
Name:NEVILLE, SHIRLEY PAGE (CRNA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:PAGE
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:ELIZABETH
Other - Last Name:NEVILLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:490 BLACKBERRY LN
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-1709
Mailing Address - Country:US
Mailing Address - Phone:843-492-5588
Mailing Address - Fax:419-821-8428
Practice Address - Street 1:300 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9142
Practice Address - Country:US
Practice Address - Phone:843-347-8037
Practice Address - Fax:843-347-8056
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR67715367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0922Medicaid
SCAN0922Medicaid