Provider Demographics
NPI:1184346546
Name:DUBOSE, KATIE CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:CHRISTINE
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:CHRISTINE
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:706 SPANISH POINTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-6983
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:106 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-3007
Practice Address - Country:US
Practice Address - Phone:406-381-8210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-129146163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse