Provider Demographics
NPI:1962081661
Name:GAUSE, KARTINA (RN)
Entity type:Individual
Prefix:
First Name:KARTINA
Middle Name:
Last Name:GAUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KARTINA
Other - Middle Name:ELAINE
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:732 FOUNTAIN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29209-5712
Mailing Address - Country:US
Mailing Address - Phone:843-610-6821
Mailing Address - Fax:
Practice Address - Street 1:732 FOUNTAIN LAKE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-5712
Practice Address - Country:US
Practice Address - Phone:843-610-6821
Practice Address - Fax:803-661-6878
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC233897163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health