Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 17675 | SC |
NPI | 1164412581 |
---|---|
Provider Name | Arden Lynn Levy |
First Address | Moore, SC 29369-9414 |
Second Address | Spartanburg, SC 29307-1357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 25/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
176758 | (05) | SC |
F97203 | (02) |