Healthcare Provider Details

I. General information

NPI: 1801421854
Provider Name (Legal Business Name): KATHRYN RADUTZKY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 BAPTIST HILL RD
YONGES ISLAND SC
29449-6916
US

IV. Provider business mailing address

5117 BAPTIST HILL RD
YONGES ISLAND SC
29449-6916
US

V. Phone/Fax

Practice location:
  • Phone: 843-889-2276
  • Fax:
Mailing address:
  • Phone: 843-889-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number249208
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: