Provider Demographics
NPI:1558738955
Name:MCCONNELL, SARA GAYLE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:GAYLE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 POCAHONTAS ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4819
Mailing Address - Country:US
Mailing Address - Phone:843-819-1519
Mailing Address - Fax:
Practice Address - Street 1:1362 MCMILLAN AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-2048
Practice Address - Country:US
Practice Address - Phone:843-819-1519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC57213163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care