Healthcare Provider Details

I. General information

NPI: 1942277355
Provider Name (Legal Business Name): SUSAN M SEIDEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9263 MEDICAL PLAZA DR STE B
CHARLESTON SC
29406-7112
US

IV. Provider business mailing address

9263 MEDICAL PLAZA DR STE B
CHARLESTON SC
29406-7112
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-7070
  • Fax: 843-553-2223
Mailing address:
  • Phone: 843-553-7070
  • Fax: 843-553-2223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN2529
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: