Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN222386 | GA |
NPI | 1003351065 |
---|---|
Provider Name | Brittany Pines |
First Address | Albany, GA 31701-1941 |
Second Address | Albany, GA 31701-1941 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2016 |
Last Update Date | 30/12/2016 |