Provider Demographics
NPI:1730550963
Name:SANDIFER, ELIZABETH A (CNM)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:SANDIFER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-259-5762
Mailing Address - Fax:803-259-3250
Practice Address - Street 1:124 WREN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1527
Practice Address - Country:US
Practice Address - Phone:803-259-5762
Practice Address - Fax:803-259-3250
Is Sole Proprietor?:No
Enumeration Date:2015-10-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25318367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ78652OtherMEDICARE
SC25318OtherMEDICAL LICENSE
SCMW0317Medicaid