Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 3073 | SC |
NPI | 1013090786 |
---|---|
Provider Name | Ms. Tammy Bennett |
First Address | Greenville, SC 29607-6943 |
Second Address | Greenville, SC 29607-6943 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 16/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP1077 | (05) | SC |
Q75420 | (02) | SC |