Provider Demographics
NPI:1710183363
Name:STAPLES, MYRTLE ANNE (APRN)
Entity Type:Individual
Prefix:MS
First Name:MYRTLE
Middle Name:ANNE
Last Name:STAPLES
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 1:1189 IRON BRIDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7401
Mailing Address - Country:US
Mailing Address - Phone:843-856-1210
Mailing Address - Fax:843-856-1189
Practice Address - Street 1:1189 IRON BRIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7401
Practice Address - Country:US
Practice Address - Phone:843-856-1210
Practice Address - Fax:843-856-1189
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC355163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory