Basic Information
| Provider Information | |||||||||
| NPI: | 1417583881 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOUZIANE | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3625 ASHLEY PHOSPHATE RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294188559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432073712 | ||||||||
| FaxNumber: | 8437642240 | ||||||||
| Practice Location | |||||||||
| Address1: | 3625 ASHLEY PHOSPHATE RD | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294188559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432073712 | ||||||||
| FaxNumber: | 8437642240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2020 | ||||||||
| LastUpdateDate: | 03/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 03/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WS0200X | 240424 | SC | Y | Nursing Service Providers | Registered Nurse | School |
No ID Information.