Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19233 | SC |
NPI | 1003208869 |
---|---|
Provider Name | Mrs. Callie Hanson Carpenter |
First Address | Florence, SC 29506-2617 |
Second Address | Florence, SC 29506-2617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2015 |
Last Update Date | 03/03/2015 |