Healthcare Provider Details

I. General information

NPI: 1164682373
Provider Name (Legal Business Name): KARENNE NSTANG FRU M.D, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARENNE NSTANG FRU MD

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 SUNSET BLVD
WEST COLUMBIA SC
29169-4716
US

IV. Provider business mailing address

2324 SUNSET BLVD
WEST COLUMBIA SC
29169-4716
US

V. Phone/Fax

Practice location:
  • Phone: 803-726-3600
  • Fax: 803-929-0504
Mailing address:
  • Phone: 803-726-3600
  • Fax: 803-929-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number201302150
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: