Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 23202 | SC |
NPI | 1225670649 |
---|---|
Provider Name | Mrs. Linda Marie Wilkerson |
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 | 17/10/2019 |
Last Update Date | 17/10/2019 |