Provider Demographics
NPI:1144765421
Name:SUMPTER, BERNICE
Entity Type:Individual
Prefix:MRS
First Name:BERNICE
Middle Name:
Last Name:SUMPTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 ROUND O RD
Mailing Address - Street 2:120 PRAYER LANE
Mailing Address - City:EUTAWVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29048-8710
Mailing Address - Country:US
Mailing Address - Phone:803-218-8034
Mailing Address - Fax:
Practice Address - Street 1:155 ROUND O RD
Practice Address - Street 2:120 PRAYER LANE
Practice Address - City:EUTAWVILLE
Practice Address - State:SC
Practice Address - Zip Code:29048-8710
Practice Address - Country:US
Practice Address - Phone:803-218-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide