Healthcare Provider Details

I. General information

NPI: 1275959280
Provider Name (Legal Business Name): NANCY A BURNHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 S LEMACKS ST
WALTERBORO SC
29488-4374
US

IV. Provider business mailing address

219 S LEMACKS ST PO BOX 229
WALTERBORO SC
29488-4374
US

V. Phone/Fax

Practice location:
  • Phone: 843-549-1516
  • Fax: 843-549-6845
Mailing address:
  • Phone: 843-549-1516
  • Fax: 843-549-6845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN84426
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: