Healthcare Provider Details

I. General information

NPI: 1679259170
Provider Name (Legal Business Name): ADRIENNE LASTINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 COURTENAY DR
CHARLESTON SC
29425-8911
US

IV. Provider business mailing address

9 WILLIAM ST
MOUNT PLEASANT SC
29464-5039
US

V. Phone/Fax

Practice location:
  • Phone: 843-876-7745
  • Fax:
Mailing address:
  • Phone: 415-608-8596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number241631
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: