Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | RN121156 | GA |
Y | 363L00000X | Nurse Practitioner | 23081 | SC |
NPI | 1124077524 |
---|---|
Provider Name | Miss Laurel Paige Davis |
First Address | Daniel Island, SC 29492-7583 |
Second Address | Daniel Island, SC 29492-7583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
23081 | NO INSURANCE TAKEN (01) | SC |