Healthcare Provider Details

I. General information

NPI: 1215070248
Provider Name (Legal Business Name): DANA LYNN HOUSEKNECHT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 PAMPLICO HWY
FLORENCE SC
29505-6019
US

IV. Provider business mailing address

2712 TRIPLE CROWN DR
FLORENCE SC
29505-8751
US

V. Phone/Fax

Practice location:
  • Phone: 843-674-2800
  • Fax:
Mailing address:
  • Phone: 843-617-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3239
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: