Healthcare Provider Details

I. General information

NPI: 1194063099
Provider Name (Legal Business Name): SANDY SUTTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2013
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 NORTH PAGE STREET
CHESTERFIELD SC
29709
US

IV. Provider business mailing address

203 N PAGE ST
CHESTERFIELD SC
29709-1201
US

V. Phone/Fax

Practice location:
  • Phone: 843-623-2206
  • Fax: 843-623-2469
Mailing address:
  • Phone: 843-623-2206
  • Fax: 843-623-2469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number43905
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number43905
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: