Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 7049 | SC |
Y | 213EG0000X | General Practice | 7049 | SC |
NPI | 1003104746 |
---|---|
Provider Name | Margaret Brunson Ondersma |
First Address | Cameron, SC 29030-9561 |
Second Address | Cameron, SC 29030-9561 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2011 |
Last Update Date | 05/01/2015 |