| Doctor Name: | MARSHA WREN SANDIFER |
| NPI Number: | 1093143836 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 18476 |
| Business Practice Address: | 19340 Solomon Blatt Ave N Blackville, SC - 298172304 |
| Business Phone Number: | 8032841045 |
| Business Fax Number: | 8032843094 |
| Mailing Address: | 19340 Solomon Blatt Ave N, BLACKVILLE |
| State: | SC |
| Postal Code: | 298172304 |
| Phone Number: | 8032841045 |
| Fax Number: | 8032843094 |
| NPI Enumeration Date: | 10/14/2013 |
| NPI Last Update Date: | 01/21/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 18476 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |