Healthcare Provider Details

I. General information

NPI: 1043936503
Provider Name (Legal Business Name): JEANNE BARCELONA TORRES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BEE ST
CHARLESTON SC
29401-5703
US

IV. Provider business mailing address

4307 NEVADA AVE APT B
CHARLESTON AFB SC
29404-5580
US

V. Phone/Fax

Practice location:
  • Phone: 843-740-6030
  • Fax:
Mailing address:
  • Phone: 845-741-1837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number267572
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: