Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2688 | SC |
NPI | 1003921933 |
---|---|
Provider Name | Brandie Taylor |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 14/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP0918 | (05) | SC |
Q54928 | (02) | SC |