Provider Demographics
NPI:1265907224
Name:GARDNER, SHERYL EDGEMON (RNC)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:EDGEMON
Last Name:GARDNER
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 LOG BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-8462
Mailing Address - Country:US
Mailing Address - Phone:803-245-5176
Mailing Address - Fax:
Practice Address - Street 1:370 LOG BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003
Practice Address - Country:US
Practice Address - Phone:803-245-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse