Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | APRN177 | SC |
NPI | 1053878256 |
---|---|
Provider Name | Marcia Leola Brafford |
First Address | Columbia, SC 29223-5501 |
Second Address | Columbia, SC 29203-6863 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2019 |
Last Update Date | 23/02/2019 |