Healthcare Provider Details

I. General information

NPI: 1578937157
Provider Name (Legal Business Name): KIRSTEN DAUTERIVE LORENZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIRSTEN DAUTERIVE BUR

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 JOHN ST STE 201
EASLEY SC
29640-1406
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-522-4630
  • Fax: 864-522-4635
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number22644
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: