Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | APN 2208 | SC |
NPI | 1083628317 |
---|---|
Provider Name | Mrs. Janet Selecman Nussbaum |
First Address | Columbia, SC 29209-1638 |
Second Address | Columbia, SC 29209-1638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2006 |
Last Update Date | 08/07/2007 |