Provider Demographics
NPI:1730384371
Name:REAL SOLUTIONS OF MURRELLS INLET INC.
Entity type:Organization
Organization Name:REAL SOLUTIONS OF MURRELLS INLET INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, BC
Authorized Official - Phone:843-357-8558
Mailing Address - Street 1:PO BOX 2792
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2664
Mailing Address - Country:US
Mailing Address - Phone:843-357-8558
Mailing Address - Fax:843-357-4349
Practice Address - Street 1:641 LITTLE TONY AVE
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6281
Practice Address - Country:US
Practice Address - Phone:843-357-8558
Practice Address - Fax:843-357-4349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26971101YM0800X
SC29671363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1457379067OtherINDIVIUAL NPI NUMBER
P247460281Medicare ID - Type Unspecified