Provider Demographics
NPI:1790338614
Name:METALLO, SUSAN B (RN, BSN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:METALLO
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 1:276 FOX CATCHER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-6687
Mailing Address - Country:US
Mailing Address - Phone:843-446-7398
Mailing Address - Fax:
Practice Address - Street 1:1931 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5482
Practice Address - Country:US
Practice Address - Phone:843-915-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39559163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health