Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 1028840 | SC |
NPI | 1164011854 |
---|---|
Provider Name | Kristin Helen Santelli |
First Address | Myrtle Beach, SC 29577-1315 |
Second Address | Myrtle Beach, SC 29577-1315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2021 |
Last Update Date | 16/01/2021 |