Healthcare Provider Details

I. General information

NPI: 1992742506
Provider Name (Legal Business Name): KATHLEEN COMLEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: KATHLEEN HURLBURT CRNA

II. Dates (important events)

Enumeration Date: 06/01/2006
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

4958 CHISOLM RD
JOHNS ISLAND SC
29455-4712
US

V. Phone/Fax

Practice location:
  • Phone: 843-402-1436
  • Fax:
Mailing address:
  • Phone: 843-559-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1698
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: