Healthcare Provider Details

I. General information

NPI: 1821414715
Provider Name (Legal Business Name): KATHLEEN GERISE ROBSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2014
Last Update Date: 03/15/2014
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

3 CHARLESTON CENTER DR
CHARLESTON SC
29401-1162
US

V. Phone/Fax

Practice location:
  • Phone: 843-579-4500
  • Fax: 843-579-4621
Mailing address:
  • Phone: 843-579-4500
  • Fax: 843-579-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR 95402
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: