Korpon, Mary Lou

Korpon, Mary Lou is an individual health care provider with primary practice located at 202 Bentons Lodge Rd , Summerville SC 29485-6322. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Korpon, Mary Lou can be contacted via phone (843) 871-2588.

Contact Information

Primary practice address
202 Bentons Lodge Rd Summerville SC 29485-6322
Phone: (843) 871-2588
Fax: (843) 871-1664
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X APN486 South Carolina

Profile Details

NPI number 1417936642
LBN Legal business name Korpon, Mary Lou
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2006
Last updated Mar 27th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417936642 NPPES
South Carolina MEDICAID NP0187

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