Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 30958 | SC |
Y | 2080P0204X | Pediatric Emergency Doctor | 30958 | SC |
NPI | 1144481763 |
---|---|
Provider Name | Carrie Elizabeth Busch |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 08/10/2020 |