Healthcare Provider Details

I. General information

NPI: 1306554373
Provider Name (Legal Business Name): CAROL LYNN BROWN-BULLOCH DBA, MN, RN, CQM/OE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E CHEVES ST
FLORENCE SC
29506-2526
US

IV. Provider business mailing address

145 E CHEVES ST
FLORENCE SC
29506-2526
US

V. Phone/Fax

Practice location:
  • Phone: 843-250-1334
  • Fax:
Mailing address:
  • Phone: 843-250-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number38367
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: