Healthcare Provider Details

I. General information

NPI: 1508103789
Provider Name (Legal Business Name): ADRIANNE J. CAULEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2013
Last Update Date: 05/27/2014
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

800 N FANT ST
ANDERSON SC
29621-5708
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-1340
  • Fax: 864-512-1749
Mailing address:
  • Phone: 864-512-1417
  • Fax: 864-512-3719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number091769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: