Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 21088 | SC |
NPI | 1013430420 |
---|---|
Provider Name | Ms. Taylor C Dieter |
First Address | Columbia, SC 29229-1613 |
Second Address | Columbia, SC 29229-1613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2017 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F06170670 | AANP CERTIFICATION (01) |