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General NPI Number Information
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NPI Number | 1467450643
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Entity Type | Individual
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Provider Name | KATHLEEN M CHANCE CRNA
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 SINGLETON RIDGE RD
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City | CONWAY
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State | SC
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Zip | 29526-9142
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Country | US
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Telephone | 843-234-5038
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Fax |
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Provider Business Mailing Address
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Address Line | 111 CLANCURRY PL
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City | PAWLEYS ISLAND
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State | SC
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Zip | 29585-6394
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Country | US
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Telephone | 843-979-0769
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 135833
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License Number State | NC
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