Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 683 | SC |
N | 222Z00000X | Podiatrist | 683 | SC |
Y | 213ES0131X | Foot Surgery | 683 | SC |
NPI | 1326570524 |
---|---|
Provider Name | Miss Amanda Jane Warner |
First Address | West Columbia, SC 29171-6069 |
Second Address | Columbia, SC 29229-7613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 11/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PD6835 | (05) | SC |