Provider Demographics
NPI:1285480020
Name:FURTICK, SHIRLEY ANN
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:FURTICK
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 1:7803 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2866
Mailing Address - Country:US
Mailing Address - Phone:803-354-6437
Mailing Address - Fax:
Practice Address - Street 1:7803 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2866
Practice Address - Country:US
Practice Address - Phone:803-354-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-2102374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty