Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist |
NPI | 1306464532 |
---|---|
Provider Name | Joanna Allen-Gibbs II |
First Address | Rembert, SC 29128-8820 |
Second Address | Rembert, SC 29128-8820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2020 |
Last Update Date | 14/07/2020 |