Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 22640 | SC |
N | 363LG0600X | Nurse Practitioner - Gerontology | 22640 | SC |
NPI | 1073173316 |
---|---|
Provider Name | Michaela Oldham |
First Address | Greenville, SC 29605-4019 |
Second Address | Greenville, SC 29605-4019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2019 |
Last Update Date | 04/10/2021 |