Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 24613 | SC |
NPI | 1073104790 |
---|---|
Provider Name | Daphne Jo Areephanthu |
First Address | West Columbia, SC 29169 |
Second Address | West Columbia, SC 29169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2021 |
Last Update Date | 19/03/2021 |