MEDICARE: SANDRA K WRIGHT FNP

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	363LF0000X	Family Nurse Practitioner	510	SC

General Provider Information

NPI Number	:	1528096310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA K WRIGHT FNP

Provider Business Mailing Address
First Line	:	1666 HIGHWAY 160 W
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8024
Country	:	US
Telephone Number	:	803-548-2247
Fax Number	:	803-548-2286

Provider Business Practice Location Address
First Line	:	1666 HIGHWAY 160 W
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29708-8024
Country	:	US
Telephone Number	:	803-548-2247
Fax Number	:	803-548-2286

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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