Healthcare Provider Details

I. General information

NPI: 1215096433
Provider Name (Legal Business Name): ETHEL LANGSTON CRANE MSN,RN,CS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WAPPOO CREEK DR SUITE 2-A
CHARLESTON SC
29412-2134
US

IV. Provider business mailing address

609 NOBLE LN
MT PLEASANT SC
29464-3509
US

V. Phone/Fax

Practice location:
  • Phone: 843-795-3585
  • Fax:
Mailing address:
  • Phone: 843-795-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRX 610
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: