Individual
THERESA K HANICAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
9263 MEDICAL PLAZA DR STE E, CHARLESTON, SC 29406-7112
(843) 572-1228
Mailing address
9263 MEDICAL PLAZA DR STE E, CHARLESTON, SC 29406-7112
(843) 572-1228
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
25550
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
10/11/2021
Last updated
11/09/2021
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