Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 82496 | SC |
NPI | 1265799225 |
---|---|
Provider Name | Colleen Jae Bressler |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-2618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2012 |
Last Update Date | 02/08/2019 |