Provider Demographics
NPI:1962837344
Name:BOTOS, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BOTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 VON KOLNITZ RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3238
Mailing Address - Country:US
Mailing Address - Phone:843-849-2805
Mailing Address - Fax:843-849-2892
Practice Address - Street 1:855 VON KOLNITZ RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3238
Practice Address - Country:US
Practice Address - Phone:843-849-2805
Practice Address - Fax:843-849-2892
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC211565163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool