Healthcare Provider Details

I. General information

NPI: 1669568093
Provider Name (Legal Business Name): DEANA GROGAN RNC, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HENRY TECKLENBURG DR
CHARLESTON SC
29414-5733
US

IV. Provider business mailing address

1286 CHART RIDGE DR
MOUNT PLEASANT SC
29466-6700
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-1682
  • Fax:
Mailing address:
  • Phone: 843-216-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number1941
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: