Healthcare Provider Details

I. General information

NPI: 1609536002
Provider Name (Legal Business Name): CAROLINE RAVENEL STRANGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 05/09/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 S LIVE OAK DR
MONCKS CORNER SC
29461-8737
US

IV. Provider business mailing address

PO BOX 751649
CHARLOTTE NC
28275-1649
US

V. Phone/Fax

Practice location:
  • Phone: 843-534-1770
  • Fax: 877-453-3943
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25646
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: