Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | A2706 | SC |
NPI | 1003872391 |
---|---|
Provider Name | Marie Davis Rataj |
First Address | Summerville, SC 29485 |
Second Address | Summerville, SC 29485 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 05/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q48313 | (02) |