Healthcare Provider Details

I. General information

NPI: 1013787423
Provider Name (Legal Business Name): DANE'CHA CHISOLM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 OLD TROLLEY RD STE 201
SUMMERVILLE SC
29485-5608
US

IV. Provider business mailing address

402 OLD TROLLEY RD STE 201
SUMMERVILLE SC
29485-5608
US

V. Phone/Fax

Practice location:
  • Phone: 843-929-9529
  • Fax:
Mailing address:
  • Phone: 843-929-9529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number245852
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number245852
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number245852
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number245852
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number245852
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number245852
License Number StateSC
# 7
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number245852
License Number StateSC
# 8
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number245852
License Number StateSC
# 9
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number245852
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: