Healthcare Provider Details

I. General information

NPI: 1699295964
Provider Name (Legal Business Name): SUNSHINE ADAMS REARDEN DNP, APRN, PNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MARINA DR
GEORGETOWN SC
29440-2410
US

IV. Provider business mailing address

435 MARINA DR
GEORGETOWN SC
29440-2410
US

V. Phone/Fax

Practice location:
  • Phone: 843-833-8595
  • Fax: 843-833-8599
Mailing address:
  • Phone: 843-833-8595
  • Fax: 843-833-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number21033
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: