Healthcare Provider Details

I. General information

NPI: 1457717977
Provider Name (Legal Business Name): CHRISTINE STREISAND RN, CCRN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 10/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

2761 COOPERS CT
MYRTLE BEACH SC
29579-3218
US

V. Phone/Fax

Practice location:
  • Phone: 843-602-2408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number19947
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: