Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 19642 | SC |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19642 | SC |
NPI | 1477939437 |
---|---|
Provider Name | Christine Gordon |
First Address | Florence, SC 29501-2808 |
Second Address | Aiken, SC 29801-6387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2015 |
Last Update Date | 18/08/2021 |