Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 24924 | SC |
NPI | 1144804048 |
---|---|
Provider Name | Mariel Haverdink |
First Address | Sumter, SC 29150-2664 |
Second Address | Sumter, SC 29150-2664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2021 |
Last Update Date | 07/05/2021 |