Healthcare Provider Details

I. General information

NPI: 1902971443
Provider Name (Legal Business Name): SANDRA WITMAN APRN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E MAIN ST
MONCKS CORNER SC
29461-3764
US

IV. Provider business mailing address

1887 PADDY PL
CHARLESTON SC
29407-3072
US

V. Phone/Fax

Practice location:
  • Phone: 843-899-4949
  • Fax: 843-899-7224
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number1292
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: