Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | SC | |
Y | 207Q00000X | Family Doctor | 38800 | SC |
NPI | 1073021549 |
---|---|
Provider Name | India Brooks |
First Address | Florence, SC 29501-3405 |
Second Address | Florence, SC 29501-3405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2018 |
Last Update Date | 08/04/2019 |