Healthcare Provider Details

I. General information

NPI: 1104882364
Provider Name (Legal Business Name): JOAN SCHROEDER WORTMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N FANT ST
ANDERSON SC
29621-5708
US

IV. Provider business mailing address

600 ST JOHNSBURY ROAD LITTLETON REGIONAL HEALTHCARE
LITTLETON NH
03561
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-1000
  • Fax:
Mailing address:
  • Phone: 603-444-9000
  • Fax: 903-686-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN793
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: