Healthcare Provider Details

I. General information

NPI: 1386049005
Provider Name (Legal Business Name): MRS. RUTH ANN SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 10/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PICKNEY BLVD
BEAUFORT SC
29902
US

IV. Provider business mailing address

7242 ACE BASIN PKWY
GREEN POND SC
29446-5428
US

V. Phone/Fax

Practice location:
  • Phone: 843-770-0444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78760
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: