Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 19752 | SC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 19752 | SC |
NPI | 1083083117 |
---|---|
Provider Name | Calla Rose Chow |
First Address | Orangeburg, SC 29118-1931 |
Second Address | Orangeburg, SC 29118-1931 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2015 |
Last Update Date | 23/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19752 | MEDICAL LICENSE (01) | SC |
NP3492 | (05) | SC |