Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 22687 | SC |
NPI | 1083278279 |
---|---|
Provider Name | Heather Michelle Martin |
First Address | Seneca, SC 29678-3026 |
Second Address | Seneca, SC 29678-2762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 04/11/2019 |