Provider Demographics
NPI:1790403657
Name:SCHWADE, STEPHEN L
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:L
Last Name:SCHWADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 CHUCK DAWLEY BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4183
Mailing Address - Country:US
Mailing Address - Phone:843-884-8045
Mailing Address - Fax:843-881-5081
Practice Address - Street 1:1122 CHUCK DAWLEY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4183
Practice Address - Country:US
Practice Address - Phone:843-884-8045
Practice Address - Fax:843-881-5081
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC27167363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program