Provider Demographics
NPI:1861608614
Name:FETTERS, NAN ELIZABETH (WHNP)
Entity type:Individual
Prefix:MS
First Name:NAN
Middle Name:ELIZABETH
Last Name:FETTERS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 QUEENSGATE WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-9069
Mailing Address - Country:US
Mailing Address - Phone:843-270-8885
Mailing Address - Fax:843-856-3760
Practice Address - Street 1:3077 QUEENSGATE WAY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9069
Practice Address - Country:US
Practice Address - Phone:843-270-8885
Practice Address - Fax:843-856-3760
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704107767163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory