Healthcare Provider Details

I. General information

NPI: 1881935351
Provider Name (Legal Business Name): KATHERINE COLLERAN KLEIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 FLINT DR
WARRENVILLE SC
29851-2352
US

IV. Provider business mailing address

567 CREEKRIDGE RD
AIKEN SC
29803-9458
US

V. Phone/Fax

Practice location:
  • Phone: 803-593-7180
  • Fax: 803-593-7112
Mailing address:
  • Phone: 803-643-0560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number25968
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: