Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2965 | SC |
N | 111NN1001X | Nutrition | 32542 | CA |
NPI | 1467430314 |
---|---|
Provider Name | Dr. Stephanie M Zgraggen |
First Address | Charleston, SC 29407-5969 |
Second Address | Charleston, SC 29407-5969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2006 |
Last Update Date | 02/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V02696 | (02) | SC |