Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 22528 | SC |
NPI | 1265906218 |
---|---|
Provider Name | Johnette Petty Touchberry |
First Address | Florence, SC 29506-2617 |
Second Address | Florence, SC 29506-2617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2019 |
Last Update Date | 13/01/2019 |