Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 08 | SC |
NPI | 1144279845 |
---|---|
Provider Name | J. Mereinda Fisher |
First Address | Lyman, SC 29365-1254 |
Second Address | Lyman, SC 29365-3726 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 13/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08 | STATE LICENSE (01) | SC |
LM0005 | (05) | SC |