Provider Demographics
NPI:1447358999
Name:BUKOWSKI, CHARITY MARIE (CRNA)
Entity type:Individual
Prefix:
First Name:CHARITY
Middle Name:MARIE
Last Name:BUKOWSKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 TAYLOR AT MARION ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210
Mailing Address - Country:US
Mailing Address - Phone:803-296-5804
Mailing Address - Fax:803-296-2548
Practice Address - Street 1:1330 TAYLOR AT MARION ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210
Practice Address - Country:US
Practice Address - Phone:803-296-5804
Practice Address - Fax:803-296-2548
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4178367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510764Medicaid
NV100510764Medicaid