Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 06110002 | TN |
Y | 176B00000X | Midwife | LMW-0053 | SC |
NPI | 1114172236 |
---|---|
Provider Name | Mrs. Carol Lynn Velasquez |
First Address | Aiken, SC 29801 |
Second Address | Aiken, SC 29801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2008 |
Last Update Date | 21/11/2012 |