Healthcare Provider Details

I. General information

NPI: 1922026384
Provider Name (Legal Business Name): LAURA FAYE BECK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 HARDEN ST EXT 5 MEDICAL PARK PALMETTO HEALTH RICHLAND
COLUMBIA SC
29203
US

IV. Provider business mailing address

1321 LADY STREET 1ST FLOOR PALMETTO HEALTH RICHLAND
COULMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2548
  • Fax: 803-296-2525
Mailing address:
  • Phone: 803-296-2548
  • Fax: 803-296-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2096
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: