Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 24687 | SC |
NPI | 1023631116 |
---|---|
Provider Name | Natasha Brady |
First Address | Atlanta, GA 30374-3904 |
Second Address | Columbia, SC 29203-8008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2020 |
Last Update Date | 20/05/2021 |