Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 19881 | SC |
NPI | 1033574231 |
---|---|
Provider Name | Mrs. Jamie Bott |
First Address | Greenville, SC 29605-4210 |
Second Address | Greenville, SC 29605-4210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2015 |
Last Update Date | 15/12/2015 |