Provider Demographics
NPI:1437115433
Name:FOOTMAN, YVONNE SUSIE (RNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:SUSIE
Last Name:FOOTMAN
Suffix:
Gender:F
Credentials:RNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 TOM POLITE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29920-6217
Mailing Address - Country:US
Mailing Address - Phone:843-838-2002
Mailing Address - Fax:
Practice Address - Street 1:719 OKATIE HWY
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-3963
Practice Address - Country:US
Practice Address - Phone:843-987-7400
Practice Address - Fax:843-987-7484
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOB349363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDNP0423Medicaid