Provider Demographics
NPI:1447593363
Name:ULCH, PETRA STEEN (RN)
Entity type:Individual
Prefix:
First Name:PETRA
Middle Name:STEEN
Last Name:ULCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2597 SC HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:WHITMIRE
Mailing Address - State:SC
Mailing Address - Zip Code:29178
Mailing Address - Country:US
Mailing Address - Phone:803-694-2320
Mailing Address - Fax:803-694-3835
Practice Address - Street 1:1539 MARTIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2831
Practice Address - Country:US
Practice Address - Phone:803-694-2320
Practice Address - Fax:803-694-3835
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213155163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool