Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | P 409 | SC |
NPI | 1861431660 |
---|---|
Provider Name | Mrs. Carlon J. Mitchell |
First Address | Charleston, SC 29407-3523 |
Second Address | Charleston, SC 29405-8415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 08/07/2007 |