Healthcare Provider Details

I. General information

NPI: 1124447727
Provider Name (Legal Business Name): SUSAN HARWOOD HARGRAVE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CHARLESTON CENTER DR
CHARLESTON SC
29401-1162
US

IV. Provider business mailing address

4050 BRIDGE VIEW DR STE 600
NORTH CHARLESTON SC
29405-8415
US

V. Phone/Fax

Practice location:
  • Phone: 843-579-4640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number33997
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: