Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 21589 | SC |
NPI | 1003337916 |
---|---|
Provider Name | Brooke Evans Chamberlain |
First Address | Charlotte, NC 28260-3898 |
Second Address | Florence, SC 29505-6081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2017 |
Last Update Date | 08/10/2020 |