MEDICARE: MS. MARY JOSEPHINE OCHIENG CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R97149	SC
2	367500000X	Certified Registered Nurse Anesthetist	3592	SC

General Provider Information

NPI Number	:	1497924427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY JOSEPHINE OCHIENG CRNA

Provider Business Mailing Address
First Line	:	116 KINGSTON TRACE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7661
Country	:	US
Telephone Number	:	803-699-5235
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 KINGSTON TRACE RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7661
Country	:	US
Telephone Number	:	803-699-5235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2008
Last Update Date	:	11/10/2020

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