Healthcare Provider Details

I. General information

NPI: 1881844538
Provider Name (Legal Business Name): MICHAEL CHARLES MENNINGER RN-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NAVAL NUCLEAR POWER TRAINING COMMAND CIR
GOOSE CREEK SC
29445
US

IV. Provider business mailing address

110 NAVAL NUCLEAR POWER TRAINING COMMAND CIR
GOOSE CREEK SC
29445
US

V. Phone/Fax

Practice location:
  • Phone: 858-794-6835
  • Fax:
Mailing address:
  • Phone: 858-794-6835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001254793
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: