Provider Demographics
NPI:1275959280
Name:BURNHAM, NANCY A (RN)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 S LEMACKS ST
Mailing Address - Street 2:PO BOX 229
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-4374
Mailing Address - Country:US
Mailing Address - Phone:843-549-1516
Mailing Address - Fax:843-549-6845
Practice Address - Street 1:219 S LEMACKS ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-4374
Practice Address - Country:US
Practice Address - Phone:843-549-1516
Practice Address - Fax:843-549-6845
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCRN84426163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn