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General NPI Number Information
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NPI Number | 1558738955
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Entity Type | Individual
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Provider Name | SARA GAYLE MCCONNELL BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 1362 MCMILLAN AVE STE 300
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City | CHARLESTON
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State | SC
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Zip | 29405-2048
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Country | US
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Telephone | 843-819-1519
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Fax |
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Provider Business Mailing Address
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Address Line | 1430 POCAHONTAS ST
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City | MOUNT PLEASANT
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State | SC
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Zip | 29464-4819
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Country | US
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Telephone | 843-819-1519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | 57213
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License Number State | SC
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