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Individual

LINDA S BOAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
2720 SUNSET BLVD, WEST COLUMBIA, SC 29169-4810
(803) 791-2000
Mailing address
2720 SUNSET BLVD, ATT CREDENTIALING, WEST COLUMBIA, SC 29169-4810
(803) 791-2000

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
22693
SC
367500000X
Certified Registered Nurse Anesthetist
Primary
R00022703
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
AN0125
SC
Enumeration date
07/25/2006
Last updated
10/27/2007
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