Provider Demographics
NPI:1750376943
Name:MURDAUGH, LAVERNE (APRN)
Entity type:Individual
Prefix:MRS
First Name:LAVERNE
Middle Name:
Last Name:MURDAUGH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:LAVERNE
Other - Middle Name:
Other - Last Name:CRIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:500 N MAIN ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6439
Mailing Address - Country:US
Mailing Address - Phone:843-832-0041
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6439
Practice Address - Country:US
Practice Address - Phone:843-832-0041
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2231363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health