| Mrs Amanda C Fowler, CRNA | |
|
1315 Roberts Street, Camden, SC 29020-3737 | |
| (803) 432-4311 | |
| (910) 715-1943 |
| Full Name | Mrs Amanda C Fowler |
|---|---|
| Gender | Female |
| Speciality | Nurse Anesthetist, Certified Registered |
| Location | 1315 Roberts Street, Camden, South Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043412695 | NPI | - | NPPES |
| AN1684 | Medicaid | SC | |
| 89111 | Other | SC | RN LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 89111 (South Carolina) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | 077506 (South Carolina) | Primary |
| Entity Name | Mcleod Regional Medical Center Of The Pee Dee, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1154371433 PECOS PAC ID: 7416851852 Enrollment ID: O20031126000251 |
| Entity Name | Mcleod Physician Associates Ii |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1801990494 PECOS PAC ID: 8224031307 Enrollment ID: O20060926000568 |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Amanda C Fowler, CRNA 1315 Roberts Street, Camden, SC 29020-3737 Ph: (803) 432-4311 | Mrs Amanda C Fowler, CRNA 1315 Roberts Street, Camden, SC 29020-3737 Ph: (803) 432-4311 |
Christopher C Cornor, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1315 Roberts Street, Camden, SC 29020 Phone: 803-432-4311 | |
Linda George Van Dam, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1315 Roberts St, Camden, SC 29020 Phone: 803-432-4311 | |
Miss Jill Cullipher Souza, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1315 Roberts St, Camden, SC 29021 Phone: 803-432-4311 | |
Todd Richard Gustafson, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 1315 Roberts St, Camden, SC 29020 Phone: 803-432-4311 | |
Jamie B Thompson, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1315 Roberts St, Camden, SC 29020 Phone: 803-432-4311 | |
Jeremiah Christian Fowler, RN Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1315 Roberts St, Camden, SC 29020 Phone: 803-432-4311 |