Provider Demographics
NPI:1366547507
Name:MACE, DONNELL RAMSEY (FNP)
Entity type:Individual
Prefix:MS
First Name:DONNELL
Middle Name:RAMSEY
Last Name:MACE
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 1:503 20TH AVE N UNIT 27D
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-2383
Mailing Address - Country:US
Mailing Address - Phone:828-403-5907
Mailing Address - Fax:
Practice Address - Street 1:800 25TH AVE S STE 12
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-4320
Practice Address - Country:US
Practice Address - Phone:843-256-6721
Practice Address - Fax:843-900-2200
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001277207Q00000X
NC132174363LF0000X
SC25840363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8919642Medicaid
NC19642OtherBC