Provider Demographics
NPI:1770670143
Name:WEATHERFORD, SANDRA (FNP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:WEATHERFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 SOUTH PAMPLICO HWY
Mailing Address - Street 2:
Mailing Address - City:PAMPLICO
Mailing Address - State:SC
Mailing Address - Zip Code:29583
Mailing Address - Country:US
Mailing Address - Phone:843-493-5252
Mailing Address - Fax:843-493-2372
Practice Address - Street 1:953 SOUTH PAMPLICO HWY
Practice Address - Street 2:
Practice Address - City:PAMPLICO
Practice Address - State:SC
Practice Address - Zip Code:29583
Practice Address - Country:US
Practice Address - Phone:843-493-5252
Practice Address - Fax:843-493-2372
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2399363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1032Medicaid
SCP13917Medicare UPIN