Provider Demographics
NPI:1457997462
Name:SMOLENSKI, DONNA JO (APRN)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:SMOLENSKI
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 1:3025 NEWCASTLE LOOP
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-4502
Mailing Address - Country:US
Mailing Address - Phone:843-215-2400
Mailing Address - Fax:843-215-2444
Practice Address - Street 1:3025 NEWCASTLE LOOP
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-4502
Practice Address - Country:US
Practice Address - Phone:843-215-2400
Practice Address - Fax:843-215-2444
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23403363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health