Healthcare Provider Details

I. General information

NPI: 1376828434
Provider Name (Legal Business Name): NATALIE DOMINIQUE VERDETTO CRNA, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 DINGLE ROAD
MOUNT PLEASANT SC
29466
US

IV. Provider business mailing address

9263 MEDICAL PLAZA DR STE E
CHARLESTON SC
29406-7112
US

V. Phone/Fax

Practice location:
  • Phone: 570-499-7570
  • Fax:
Mailing address:
  • Phone: 843-572-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN588202
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number21974A
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: