Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 20404 | SC |
NPI | 1013458751 |
---|---|
Provider Name | Brittain Williams Gibbs |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29414-5783 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2017 |
Last Update Date | 16/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20404 | SC MEDICAL LICENSE (01) | SC |
NP6348 | (05) | SC |