Provider Demographics
NPI:1831749076
Name:SCUDERI, DONNA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:SCUDERI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 FABER PLACE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8522
Mailing Address - Country:US
Mailing Address - Phone:843-266-3824
Mailing Address - Fax:
Practice Address - Street 1:3841 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-7469
Practice Address - Country:US
Practice Address - Phone:843-529-7349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22940363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNONEOtherTHIS FACILITY DOES NOT BILL ANY INSURANCE COMPANIES