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NPI Code Detail

MEDICARE: MRS. JAMIE EDENS GILLIGAN CRNA

MEDICARE: MRS. JAMIE EDENS GILLIGAN 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
1163W00000XRegistered Nurse236151NC
2367500000XCertified Registered Nurse Anesthetist17885SC

General Provider Information

NPI Number : 1972860344
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAMIE EDENS GILLIGAN CRNA
Provider Business Mailing Address
First Line : 120 GATEWAY CORPORATE BLVD
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-9611
Country : US
Telephone Number : 828-230-6487
Fax Number :
Provider Business Practice Location Address
First Line : 120 GATEWAY CORPORATE BLVD
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-9611
Country : US
Telephone Number : 828-230-6487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2012
Last Update Date : 07/17/2012

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