Provider Demographics
NPI:1609531540
Name:RAVENELL, EUNICE P
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:P
Last Name:RAVENELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 BALBRIGGAN DR
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5756
Mailing Address - Country:US
Mailing Address - Phone:843-270-2165
Mailing Address - Fax:
Practice Address - Street 1:143 BALBRIGGAN DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5756
Practice Address - Country:US
Practice Address - Phone:843-270-2165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC374J00000XMedicaid