Provider Demographics
NPI:1639227309
Name:TESTERMAN, CARLIE ARTHUR (APRN / CRNA)
Entity Type:Individual
Prefix:MR
First Name:CARLIE
Middle Name:ARTHUR
Last Name:TESTERMAN
Suffix:
Gender:M
Credentials:APRN / CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 EMILY DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-8478
Mailing Address - Country:US
Mailing Address - Phone:864-249-3156
Mailing Address - Fax:864-249-3156
Practice Address - Street 1:130 EMILY DRIVE
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:SC
Practice Address - Zip Code:29369
Practice Address - Country:US
Practice Address - Phone:864-249-3156
Practice Address - Fax:864-249-3156
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC83492163W00000X
IL039045367500000X
SC3947163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2608145Medicare PIN