Healthcare Provider Details

I. General information

NPI: 1194726414
Provider Name (Legal Business Name): KATHRYN ANNE VANRAVENSTEIN A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WITSELL ST
WALTERBORO SC
29488-3052
US

IV. Provider business mailing address

PO BOX 751461
CHARLOTTE NC
28275-1461
US

V. Phone/Fax

Practice location:
  • Phone: 843-549-5546
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19358
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: