Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 19404 | MS |
N | 207K00000X | Allergist & Immunologist | 38389 | TN |
Y | 207K00000X | Allergist & Immunologist | TL30868 | SC |
N | 208000000X | Pediatrician | 30868 | SC |
N | 2080P0201X | Pediatric Allergist | 30868 | SC |
NPI | 1114963188 |
---|---|
Provider Name | Maria Rudisill Streck |
First Address | Charlotte, NC 28260-2108 |
Second Address | Mt Pleasant, SC 29464-5525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 15/10/2020 |