Provider Demographics
NPI:1033650213
Name:OLTMAN, SAYWARD (NP)
Entity Type:Individual
Prefix:MRS
First Name:SAYWARD
Middle Name:
Last Name:OLTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 EAST CLARK STREET
Mailing Address - Street 2:
Mailing Address - City:PINEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29125
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:803-452-5712
Practice Address - Street 1:25 EAST CLARK STREET
Practice Address - Street 2:
Practice Address - City:PINEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29125
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:803-452-5712
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000684363LF0000X
SC25818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP8450Medicaid