Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 20991 | SC |
NPI | 1457396053 |
---|---|
Provider Name | Laure A.n. Utecht |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29615-3593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2006 |
Last Update Date | 04/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209919 | (05) | SC |
370017228 | RR MEDICARE (01) | SC |
576007863095 | BCBS OF SC ID (01) | SC |
576007863096 | BLUE CHOICE OF SC (01) | SC |
7928169 | AETNA ID (01) | SC |
H20619 | (02) | SC |