Healthcare Provider Details

I. General information

NPI: 1033650213
Provider Name (Legal Business Name): SAYWARD OLTMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 EAST CLARK STREET
PINEWOOD SC
29125
US

IV. Provider business mailing address

25 EAST CLARK STREET
PINEWOOD SC
29125
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-4500
  • Fax: 803-452-5712
Mailing address:
  • Phone: 803-774-4500
  • Fax: 803-452-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017000684
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25818
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: