Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | ME96449 | FL |
Y | 208000000X | Pediatrician | 24949 | SC |
N | 208000000X | Pediatrician | ME96449 | FL |
NPI | 1396763546 |
---|---|
Provider Name | Dr. Laura Holland Luke |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29204-4034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 12/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101465300 | (05) | FL |
249494 | (05) | SC |