Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 18880 | SC |
NPI | 1073845277 |
---|---|
Provider Name | Delphine Vanderstraeten |
First Address | Columbia, SC 29203 |
Second Address | Columbia, SC 29203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2010 |
Last Update Date | 17/12/2014 |