Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20418 | SC |
NPI | 1003360637 |
---|---|
Provider Name | Dr. Brooke Patterson |
First Address | West Columbia, SC 29169-4800 |
Second Address | Lexington, SC 29072-9041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2016 |
Last Update Date | 11/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
212048 | SC LICENSE # (01) | SC |