MEDICARE: SADIE ROSE KNIGHTS RN BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	271473	SC

General Provider Information

NPI Number	:	1487491684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SADIE ROSE KNIGHTS RN BSN

Provider Business Mailing Address
First Line	:	234 BAYBERRY PARC DR APT 403
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8921
Country	:	US
Telephone Number	:	541-324-0161
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 BAYBERRY PARC DR APT 403
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29492-8921
Country	:	US
Telephone Number	:	541-324-0161
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/15/2024

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