Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 22900 | SC |
NPI | 1003453424 |
---|---|
Provider Name | Mr. Matthew Fischer |
First Address | Mauldin, SC 29662-2423 |
Second Address | Kinston, NC 28504-2052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2019 |
Last Update Date | 04/12/2019 |