Healthcare Provider Details

I. General information

NPI: 1437115433
Provider Name (Legal Business Name): YVONNE SUSIE FOOTMAN RNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 OKATIE HWY
OKATIE SC
29909-3963
US

IV. Provider business mailing address

11 TOM POLITE DR
SAINT HELENA ISLAND SC
29920-6217
US

V. Phone/Fax

Practice location:
  • Phone: 843-987-7400
  • Fax: 843-987-7484
Mailing address:
  • Phone: 843-838-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberOB349
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: