Provider Demographics
NPI:1760801393
Name:BENNETT, SHARON (RN)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BENNETT
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 1:500 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6439
Mailing Address - Country:US
Mailing Address - Phone:843-832-0041
Mailing Address - Fax:843-851-9735
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6439
Practice Address - Country:US
Practice Address - Phone:843-832-0041
Practice Address - Fax:843-851-9735
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC56734163W00000X, 163WC1500X, 163WM0102X, 163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support