Healthcare Provider Details

I. General information

NPI: 1467544254
Provider Name (Legal Business Name): SANDRA NORCROSS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 STUART ST MONCRIEF ARMY COMMUNITY HOSPITAL
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

507 GUILD HALL DR
COLUMBIA SC
29212-1915
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2618
  • Fax: 803-751-2689
Mailing address:
  • Phone: 803-751-5035
  • Fax: 803-751-5283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR 71834
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: