Healthcare Provider Details

I. General information

NPI: 1720045461
Provider Name (Legal Business Name): DANA L KATZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 CEDAR DR
SAINT STEPHEN SC
29479-3371
US

IV. Provider business mailing address

PO BOX 100523
FLORENCE SC
29502-0523
US

V. Phone/Fax

Practice location:
  • Phone: 843-567-4000
  • Fax: 843-567-3000
Mailing address:
  • Phone: 843-669-5162
  • Fax: 843-667-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1176
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: