Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2284 | SC |
NPI | 1023058716 |
---|---|
Provider Name | Mrs. Margaret Elaine Tanner |
First Address | Hemingway, SC 29554-5818 |
Second Address | Lake City, SC 29560-2107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |