Provider Demographics
NPI:1053729616
Name:MAGGIO, JOHANNA MELODIE (DNP, AAHIVS)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MELODIE
Last Name:MAGGIO
Suffix:
Gender:F
Credentials:DNP, AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 OLD FIELD RD
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-7748
Mailing Address - Country:US
Mailing Address - Phone:609-287-9730
Mailing Address - Fax:
Practice Address - Street 1:3583 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5002
Practice Address - Country:US
Practice Address - Phone:609-287-9730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306952-1363LP2300X
SC22360363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care