Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT-186497 | PA |
Y | 2080P0202X | Pediatric Cardiologist | 33663 | SC |
NPI | 1215072855 |
---|---|
Provider Name | Nicole Brooks Cain |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MT-186497 | MEDICAL TRAINING LICENCE (01) | PA |