Provider Demographics
NPI:1801222377
Name:CAULDER, AILENE G
Entity Type:Individual
Prefix:
First Name:AILENE
Middle Name:G
Last Name:CAULDER
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 1:410 N BEAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:SC
Mailing Address - Zip Code:29563-5152
Mailing Address - Country:US
Mailing Address - Phone:843-759-5190
Mailing Address - Fax:
Practice Address - Street 1:200 BROAD ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-2532
Practice Address - Country:US
Practice Address - Phone:843-464-3740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP31486164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse