Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 18671 | SC |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 18671 | SC |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 18671 | SC |
NPI | 1003230780 |
---|---|
Provider Name | Mr. Richard Dale Brinson |
First Address | Moncks Corner, SC 29461-9227 |
Second Address | North Charleston, SC 29406-9104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2014 |
Last Update Date | 06/03/2014 |