Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 229990 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | 30352 | SC |
NPI | 1164506002 |
---|---|
Provider Name | Gretchen Kaneb |
First Address | Greenville, SC 29605-4270 |
Second Address | Greenville, SC 29605-4270 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 04/04/2017 |