Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 18340 | SC |
NPI | 1073951182 |
---|---|
Provider Name | Jill Garrison Joseph |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29615-6300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2013 |
Last Update Date | 25/08/2017 |