Provider Demographics
NPI:1558587725
Name:CALDWELL, ALICE DUNKELBERG (RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:DUNKELBERG
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6901
Mailing Address - Country:US
Mailing Address - Phone:803-799-1700
Mailing Address - Fax:803-254-3678
Practice Address - Street 1:201 CASHUA ST
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-3301
Practice Address - Country:US
Practice Address - Phone:843-393-7452
Practice Address - Fax:843-393-6210
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1213363LF0000X
SCAPN1213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0525Medicaid
SCFQC089Medicaid
SCFQC089Medicaid
SCP23127Medicare UPIN