Healthcare Provider Details

I. General information

NPI: 1609835347
Provider Name (Legal Business Name): CHARLOTTE MARIE MCREARY RN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 ADAMS GROVE RD
COLUMBIA SC
29203-6951
US

IV. Provider business mailing address

5 ROBIN HOOD CT
COLUMBIA SC
29205-2861
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-0531
  • Fax: 803-765-9052
Mailing address:
  • Phone: 803-738-9422
  • Fax: 803-765-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPN 210
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: