Healthcare Provider Details

I. General information

NPI: 1750128047
Provider Name (Legal Business Name): SARAH SIMMONS LAWRANCE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 FERRY FIELD DR
SUMMERVILLE SC
29485-9321
US

IV. Provider business mailing address

5012 FERRY FIELD DR
SUMMERVILLE SC
29485-9321
US

V. Phone/Fax

Practice location:
  • Phone: 910-262-6691
  • Fax:
Mailing address:
  • Phone: 910-262-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number277168
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8336
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: