Provider Demographics
NPI:1205977667
Name:ESPER, CARMEN (CRNA)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:ESPER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 MITCHELL ST
Mailing Address - Street 2:BOX 690001
Mailing Address - City:LORIS
Mailing Address - State:SC
Mailing Address - Zip Code:29569-9601
Mailing Address - Country:US
Mailing Address - Phone:843-716-7000
Mailing Address - Fax:843-716-7093
Practice Address - Street 1:3655 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:LORIS
Practice Address - State:SC
Practice Address - Zip Code:29569-9601
Practice Address - Country:US
Practice Address - Phone:843-716-7000
Practice Address - Fax:843-716-7093
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93225367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC400649Medicaid
SC400649Medicaid