1437115433 NPI number — MS. YVONNE SUSIE FOOTMAN RNP, MSN

Table of content: MS. YVONNE SUSIE FOOTMAN RNP, MSN (NPI 1437115433)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437115433 NPI number — MS. YVONNE SUSIE FOOTMAN RNP, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOOTMAN
Provider First Name:
YVONNE
Provider Middle Name:
SUSIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RNP, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437115433
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 TOM POLITE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT HELENA ISLAND
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29920-6217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-838-2002
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
719 OKATIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKATIE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29909-3963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-987-7400
Provider Business Practice Location Address Fax Number:
843-987-7484
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  OB349 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NP0423 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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