Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 17933 | SC |
NPI | 1013257260 |
---|---|
Provider Name | Mrs. Jacqueline C. Myers |
First Address | Seneca, SC 29678-1637 |
Second Address | Spartanburg, SC 29302-1685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2013 |
Last Update Date | 26/02/2013 |