Healthcare Provider Details

I. General information

NPI: 1881037547
Provider Name (Legal Business Name): NINA LEWIS DULLE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NINA LEWIS HOLMANM CRNA

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 01/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 HOSPITAL DR
MT PLEASANT SC
29464-3764
US

IV. Provider business mailing address

2000 HOSPITAL DR
MT PLEASANT SC
29464-3764
US

V. Phone/Fax

Practice location:
  • Phone: 843-881-0100
  • Fax:
Mailing address:
  • Phone: 843-881-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18820
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: