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Individual

THERESA JAMESON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
3000 ST. MATTHEWS ROAD, ORANGEBURG, SC 29118
(803) 454-2613
(803) 765-1732
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 765-1838
(803) 765-1732

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
403
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000163661
UNISON
SC
01
20010745
FIRST CHOICE
SC
01
576008010006
BLUE CHOICE
SC
01
576008010009
BCBS
SC
01
576008010015
TRICARE
SC
05
AN0273
SC
Enumeration date
04/20/2006
Last updated
04/28/2008
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