Healthcare Provider Details

I. General information

NPI: 1215936422
Provider Name (Legal Business Name): NELDA BECK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S PARKER DR
FLORENCE SC
29501-6059
US

IV. Provider business mailing address

PO BOX 6467
FLORENCE SC
29502-6467
US

V. Phone/Fax

Practice location:
  • Phone: 843-679-3251
  • Fax: 843-679-3251
Mailing address:
  • Phone: 843-679-3251
  • Fax: 843-679-3251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number199996
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN2884
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: