Healthcare Provider Details

I. General information

NPI: 1851728018
Provider Name (Legal Business Name): NICHOLAS J RUA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7000
  • Fax:
Mailing address:
  • Phone: 803-434-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number101311
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: