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General NPI Number Information
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NPI Number | 1558388421
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Entity Type | Individual
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Provider Name | KEVIN H ROERDEN CRNA
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Gender | Male
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 501 ROBERTSON BLVD
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City | WALTERBORO
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State | SC
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Zip | 29488-2787
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Country | US
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Telephone | 843-549-0720
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Fax | 843-549-6254
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Provider Business Mailing Address
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Address Line | PO BOX 869
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City | FOLLY BEACH
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State | SC
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Zip | 29439-0869
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Country | US
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Telephone | 843-588-6378
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Fax | 843-588-6378
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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 | 1996
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License Number State | SC
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