Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TH0100X | Health Service | 3014415 | SC |
NPI | 1104474238 |
---|---|
Provider Name | Mamie Duck |
First Address | Sumter, SC 29154-6247 |
Second Address | Sumter, SC 29154-6247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2019 |
Last Update Date | 02/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044139 | NURSE LICENSED (01) | |
3014415 | (05) | SC |
3014415 | WE KARE HOME CARE AGENCY (01) | SC |