Provider Demographics
NPI:1811069537
Name:PISCITELLO, MARY CHARLOTTE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CHARLOTTE
Last Name:PISCITELLO
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:35 BILL FRIES DR
Mailing Address - Street 2:BUILDING J
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29926-2730
Mailing Address - Country:US
Mailing Address - Phone:843-681-2222
Mailing Address - Fax:843-681-2541
Practice Address - Street 1:35 BILL FRIES DR
Practice Address - Street 2:BUILDING J
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2730
Practice Address - Country:US
Practice Address - Phone:843-681-2222
Practice Address - Fax:843-681-2541
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCR79761363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA13166896Medicare ID - Type Unspecified