Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 19227 | SC |
NPI | 1194114165 |
---|---|
Provider Name | Katherine Vincent |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2015 |
Last Update Date | 22/01/2015 |