Healthcare Provider Details

I. General information

NPI: 1447278858
Provider Name (Legal Business Name): DIANA J WARD CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 PAMPLICO HWY
FLORENCE SC
29505-6019
US

IV. Provider business mailing address

PO BOX 10925
KNOXVILLE TN
37939-0925
US

V. Phone/Fax

Practice location:
  • Phone: 843-664-3301
  • Fax: 843-664-3723
Mailing address:
  • Phone: 865-766-8800
  • Fax: 865-450-9374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN913
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: