Healthcare Provider Details

I. General information

NPI: 1922095157
Provider Name (Legal Business Name): ROSALIND KAY CRENSHAW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 UNIVERSITY PKWY
AIKEN SC
29801-6302
US

IV. Provider business mailing address

4222 AERIE CIR
EVANS GA
30809-4884
US

V. Phone/Fax

Practice location:
  • Phone: 803-641-5489
  • Fax: 803-641-5148
Mailing address:
  • Phone: 706-447-8850
  • Fax: 706-447-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR86537
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: