Individual
KITTIPONG SRISUWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
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
006184
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
20777
SC
Other
Enumeration date
02/17/2017
Last updated
12/19/2022
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