Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 19117 | SC |
N | 363L00000X | Nurse Practitioner | 5006460 | NC |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 19117 | SC |
NPI | 1093141004 |
---|---|
Provider Name | Mollie Carter |
First Address | West Columbia, SC 29171-6069 |
Second Address | Columbia, SC 29212-1181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2013 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093141004 | (05) | NC |