Healthcare Provider Details

I. General information

NPI: 1487875704
Provider Name (Legal Business Name): SHAWNA M.W. VANVALKENBURG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MEDICAL PARK DRIVE
COLUMBIA SC
29010
US

IV. Provider business mailing address

9 SHADY CREEK COURT
IRMO SC
29063
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-5000
  • Fax:
Mailing address:
  • Phone: 803-781-3008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3229
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: