Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 24664 | SC |
NPI | 1003494154 |
---|---|
Provider Name | Mrs. Angela Kathline Naples |
First Address | Conway, SC 29526-6575 |
Second Address | Myrtle Beach, SC 29572-4607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2021 |
Last Update Date | 31/03/2021 |