Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 19923 | SC |
NPI | 1003276676 |
---|---|
Provider Name | Mrs. Erin Kosak |
First Address | Charleston, SC 29412-2135 |
Second Address | Charleston, SC 29412-2135 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 25/02/2016 |