Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4704301294 | MI |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 22737 | SC |
NPI | 1003306994 |
---|---|
Provider Name | Lien Lieve Swieringa |
First Address | Atlanta, GA 31193-5722 |
Second Address | Columbia, SC 29204-2025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2018 |
Last Update Date | 25/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP6150 | (05) | SC |