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NPI Code Detail

MEDICARE: MS. YVONNE SUSIE FOOTMAN RNP, MSN

MEDICARE: MS. YVONNE SUSIE FOOTMAN RNP, MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LX0001XObstetrics & Gynecology Nurse PractitionerOB349SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437115433
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. YVONNE SUSIE FOOTMAN RNP, MSN
Provider Business Mailing Address
First Line : 11 TOM POLITE DR
Second Line :
City : SAINT HELENA ISLAND
State : SC
Zip : 29920-6217
Country : US
Telephone Number : 843-838-2002
Fax Number :
Provider Business Practice Location Address
First Line : 719 OKATIE HWY
Second Line :
City : OKATIE
State : SC
Zip : 29909-3963
Country : US
Telephone Number : 843-987-7400
Fax Number : 843-987-7484
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 03/10/2020

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