Individual
SELENE R FORRESTALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
805 PAMPLICO HWY, FLORENCE, SC 29505-6047
(843) 792-1414
Mailing address
PO BOX 23321, NEW YORK, NY 10087-3321
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
22437
SC
367500000X
Certified Registered Nurse Anesthetist
254742
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AN2850
—
SC
Enumeration date
12/13/2006
Last updated
10/31/2022
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