Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 23389 | SC |
NPI | 1801434402 |
---|---|
Provider Name | Megan Colleen Brogan |
First Address | Fort Mill, SC 29708-7713 |
Second Address | Columbia, SC 29204-2415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2019 |
Last Update Date | 13/12/2019 |