Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 18055 | SC |
NPI | 1013258193 |
---|---|
Provider Name | Mary Elizabeth Fairchilds |
First Address | Atlanta, GA 30374-3294 |
Second Address | Greenville, SC 29601-3973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2013 |
Last Update Date | 21/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP2889 | (05) | SC |