Healthcare Provider Details

I. General information

NPI: 1972565455
Provider Name (Legal Business Name): CELESTE ANNE CORNISH RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 JOHNNIE DODDS BLVD SUITE 100
MT PLEASANT SC
29464-3154
US

IV. Provider business mailing address

887 JOHNNIE DODDS BLVD SUITE 100
MT PLEASANT SC
29464-3154
US

V. Phone/Fax

Practice location:
  • Phone: 843-388-0606
  • Fax: 843-388-0607
Mailing address:
  • Phone: 843-388-0606
  • Fax: 843-388-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number34576
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: