Basic Information
| Provider Information | |||||||||
| NPI: | 1609457431 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MIMMS | ||||||||
| FirstName: | BRITTANY | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777000 | ||||||||
| FaxNumber: | 8437777005 | ||||||||
| Practice Location | |||||||||
| Address1: | 506 E CHEVES ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437777000 | ||||||||
| FaxNumber: | 8437777005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2021 | ||||||||
| LastUpdateDate: | 06/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 230794 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 367500000X | 25015 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.