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General NPI Number Information
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NPI Number | 1982742581
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Entity Type | Organization
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Legal Business Name | REST EASY CRNA SERVICES, LLC
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 101 SURGEONS DR
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City | MYRTLE BEACH
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State | SC
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Zip | 29579-5198
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Country | US
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Telephone | 843-669-5162
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Fax | 843-667-4573
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Provider Business Mailing Address
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Address Line | PO BOX 100523
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City | FLORENCE
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State | SC
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Zip | 29501-0523
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Country | US
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Telephone | 843-669-5162
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Fax | 843-667-4573
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | SHARON G. COTTON
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Credential | CRNA
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Telephone | 843-902-0143
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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 | 3024
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License Number State | SC
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