Healthcare Provider Details

I. General information

NPI: 1538121397
Provider Name (Legal Business Name): CAROLE ANNETTE FRUSCELLO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SOUTH WELLS AVENUE SUITE 106 ATCA,INC.
RENO NV
89502
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-414-9576
  • Fax:
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN2372
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: