Healthcare Provider Details

I. General information

NPI: 1710428420
Provider Name (Legal Business Name): KIMBERLY DANA HUFFSTETLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 02/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 SAINT MATTHEWS RD
ORANGEBURG SC
29118-1442
US

IV. Provider business mailing address

159 N BEAVER DAM RD
COLUMBIA SC
29212-1631
US

V. Phone/Fax

Practice location:
  • Phone: 803-533-2200
  • Fax:
Mailing address:
  • Phone: 803-600-2949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number21005
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: