Provider Demographics
NPI:1194474296
Name:BUCK, SANDRA (RN)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BUCK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 HIDDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-8128
Mailing Address - Country:US
Mailing Address - Phone:843-693-1843
Mailing Address - Fax:
Practice Address - Street 1:598 HIDDEN BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8128
Practice Address - Country:US
Practice Address - Phone:843-693-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC50866163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health