Healthcare Provider Details

I. General information

NPI: 1538838719
Provider Name (Legal Business Name): CAITLIN DEAN OBRIEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLIN DEAN APRN

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9231 MEDICAL PLAZA DR
NORTH CHARLESTON SC
29406-9101
US

IV. Provider business mailing address

183 HARBOUR WATCH WAY
MOUNT PLEASANT SC
29464-2857
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-7715
  • Fax:
Mailing address:
  • Phone: 443-262-5903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25388
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: