Individual
CAROL E. PETHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1340
(864) 512-1749
Mailing address
800 N FANT ST, ANDERSON, SC 29621-5708
(864) 512-1417
(864) 512-1823
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
083407
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20101737
SELECT HEALTH OF SC
SC
05
—
AN2036
—
SC
01
—
NPI #
TRICARE (HUMANA)
SC
01
—
NPI/SSN
BLUECROSS BLUESHIELD OF SC
SC
01
—
P00911158
RAILROAD MEDICARE
SC
Enumeration date
02/03/2010
Last updated
05/12/2011
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