Basic Information
| Provider Information | |||||||||
| NPI: | 1023426368 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYE | ||||||||
| FirstName: | CODY | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 206 ELIZABETH AVE | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296463815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642278242 | ||||||||
| FaxNumber: | 8642278148 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 SPRING ST | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | GREENWOOD | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296463860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8642278242 | ||||||||
| FaxNumber: | 8642278148 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2014 | ||||||||
| LastUpdateDate: | 07/31/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | APN.18973 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | APN.18973 | 01 | SC | SC LICENSE | OTHER |