Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 20716 | SC |
NPI | 1013454073 |
---|---|
Provider Name | Chekita Rena Legette |
First Address | Columbia, SC 29220-0001 |
Second Address | Columbia, SC 29220-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2017 |
Last Update Date | 27/01/2017 |