Healthcare Provider Details

I. General information

NPI: 1932123791
Provider Name (Legal Business Name): RAE ROGERS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N WASHINGTON ST
SUMTER SC
29150-4949
US

IV. Provider business mailing address

129 NORTH WASHINGTON STREET
SUMTER SC
29150
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-5203
  • Fax:
Mailing address:
  • Phone: 803-774-8726
  • Fax: 803-774-9846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2247
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: