Healthcare Provider Details

I. General information

NPI: 1629323654
Provider Name (Legal Business Name): CHELSEA RENEE COLOMBO ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 W FARIS RD STE 580
GREENVILLE SC
29605-4281
US

IV. Provider business mailing address

300 E MCBEE AVE STE 401
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-7874
  • Fax: 864-455-8933
Mailing address:
  • Phone: 864-522-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number25481
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number2007026752
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: