Healthcare Provider Details

I. General information

NPI: 1710715792
Provider Name (Legal Business Name): CHARWANA N. JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 BRIDLE CIR
FLORENCE SC
29505-7026
US

IV. Provider business mailing address

44 PUBLIC SQ STE 100
DARLINGTON SC
29532-3220
US

V. Phone/Fax

Practice location:
  • Phone: 843-598-6093
  • Fax:
Mailing address:
  • Phone: 843-598-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number207063
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: