Provider Demographics
NPI:1255931465
Name:BRONG, MICHELLE ELAINE (CNM)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:ELAINE
Last Name:BRONG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3208
Mailing Address - Country:US
Mailing Address - Phone:832-818-1123
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL DR STE 270
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3244
Practice Address - Country:US
Practice Address - Phone:843-818-1123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24320367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMW0294Medicaid