Healthcare Provider Details

I. General information

NPI: 1336321405
Provider Name (Legal Business Name): REGIS JOEL CHAUVOT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL ST
MANNING SC
29102-0550
US

IV. Provider business mailing address

PO BOX 550
MANNING SC
29102-0550
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-8463
  • Fax: 803-435-3196
Mailing address:
  • Phone: 803-435-8463
  • Fax: 803-435-3196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA37309
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN372
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: