Individual
LUCILLE MILEY SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
333 REVOLUTIONARY TRL, FAIRFAX, SC 29827-7109
(803) 632-2533
(803) 632-2451
Mailing address
86 WREN ST, BARNWELL, SC 29812-1529
(803) 259-5762
(803) 536-0998
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
49
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49
MEDICAL LICENSE
SC
05
—
NP0070
—
SC
Enumeration date
08/10/2006
Last updated
01/11/2024
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