Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20170 | SC |
NPI | 1003265380 |
---|---|
Provider Name | Jenny O'neill |
First Address | Columbia, SC 29223-4516 |
Second Address | Columbia, SC 29223-4516 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 08/06/2016 |