Basic Information
| Provider Information | |||||||||
| NPI: | 1598040255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SNEAD | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4975 LACROSS RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | NORTH CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294066531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437379467 | ||||||||
| FaxNumber: | 8435732534 | ||||||||
| Practice Location | |||||||||
| Address1: | 2067 CHARLIE HALL BLVD | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435732535 | ||||||||
| FaxNumber: | 8435732534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2011 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N72400 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics | 363L00000X | 23213 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | NP7225 | 05 | SC | MEDICAID |