Basic Information
| Provider Information | |||||||||
| NPI: | 1538152376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VARELLA | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 SIGMA DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | SUMMERVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294867715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435721200 | ||||||||
| FaxNumber: | 8435530424 | ||||||||
| Practice Location | |||||||||
| Address1: | 9313 MEDICAL PLAZA DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435721200 | ||||||||
| FaxNumber: | 8435530424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 83 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | P00891757 | 01 | SC | RR-MEDICARE | OTHER | GP1551 | 01 | SC | MEDICAID GROUP FOR ELMS CTR | OTHER | NP0493 | 05 | SC | MEDICAID |