Provider Demographics
NPI:1235155011
Name:REYNOLDS, SARAH GAMBLE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GAMBLE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:S
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-3513
Mailing Address - Country:US
Mailing Address - Phone:843-354-5453
Mailing Address - Fax:
Practice Address - Street 1:164 WACCAMAW MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8903
Practice Address - Country:US
Practice Address - Phone:843-347-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC40863163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health