Provider Demographics
NPI:1245685171
Name:AMERSON, ETHEL JANE (RN, MSN)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:JANE
Last Name:AMERSON
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 THOMASENA MCPHERSON BLVD, NURSING MODULE
Mailing Address - Street 2:CHARLESTON COUNTY SCHOOL DISTRICE
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405
Mailing Address - Country:US
Mailing Address - Phone:843-745-2179
Mailing Address - Fax:843-745-2182
Practice Address - Street 1:3180 THOMASENA MCPHERSON BLVD, NURSING MODULE
Practice Address - Street 2:CHARLESTON COUNTY SCHOOL DISTRICE
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405
Practice Address - Country:US
Practice Address - Phone:843-745-2179
Practice Address - Fax:843-745-2182
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26359163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse