Individual
DIANE W FOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
25 E BAY ST, GEORGETOWN, SC 29440-3788
(843) 546-5025
Mailing address
25 E BAY ST, GEORGETOWN, SC 29440-3788
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
209006226
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
APN550
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430024203
RAILROAD MEDICARE
SC
05
—
AN0061
—
SC
Enumeration date
07/22/2005
Last updated
01/23/2015
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