Provider Demographics
NPI:1538755301
Name:MACKIN, SHANA J (NP-C)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:J
Last Name:MACKIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4731 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5127
Mailing Address - Country:US
Mailing Address - Phone:843-839-7246
Mailing Address - Fax:843-839-7323
Practice Address - Street 1:4731 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5127
Practice Address - Country:US
Practice Address - Phone:843-839-7246
Practice Address - Fax:843-839-7323
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24524363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care