Shannon Dawn Kretz

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PR40574 Issued in SC

Practice address

164 Waccamaw Medical Park Dr
Conway, SC 29526-8903

Phone

(843) 347-4888

NPI assigned

Jan 24, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358985600000",
    "number": "1710225867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 WACCAMAW MEDICAL PARK DR",
            "city": "CONWAY",
            "state": "SC",
            "postal_code": "295268903",
            "telephone_number": "843-347-4888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRETZ",
        "first_name": "SHANNON",
        "middle_name": "DAWN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2013-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "SC",
            "license": "PR40574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Kodsi, MD
• Jennifer E Koperli
• Constance Koprowicz, BA, CACP
• Julie Nicole Kosatschenko, FNP-C
• Nicole Kremer, PHARMD
• Carole Krieger, LCSW, LISW
• Tabitha Krosi, RN
• KRT Enterprises
• Raymond Leonard Krzyzaniak, M.D.
• Dhruva Kumbhani, AUD

• Licensed Practical Nurse in Conway, SC
• Providers in Conway, SC by specialty
• Licensed Practical Nurse in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.