Provider Demographics
NPI:1437978954
Name:FISHBURNE, MARGUERITE LOUISE (FNP-BC)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:LOUISE
Last Name:FISHBURNE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-4126
Mailing Address - Country:US
Mailing Address - Phone:443-686-1893
Mailing Address - Fax:
Practice Address - Street 1:300 RUBY ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2758
Practice Address - Country:US
Practice Address - Phone:843-549-5599
Practice Address - Fax:843-549-5512
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29508363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care