Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 33249 | SC |
N | 2080P0203X | Pediatric Critical Care Doctor | A101152 | CA |
NPI | 1104920537 |
---|---|
Provider Name | Dr. Melissa C Evans |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12125 | (02) |