Provider Demographics
NPI:1962289306
Name:CHRISTIE COLCLOUGH, DANA (RN, BSN)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:CHRISTIE COLCLOUGH
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:MRS
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:COLCLOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:226 CAMBER RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7285
Mailing Address - Country:US
Mailing Address - Phone:803-467-6447
Mailing Address - Fax:
Practice Address - Street 1:151 RUTLEDGE AVE BLDG A
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8903
Practice Address - Country:US
Practice Address - Phone:843-792-3328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse