Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 20916 | SC |
NPI | 1003340977 |
---|---|
Provider Name | Ning Sun |
First Address | Anderson, SC 29621-1108 |
Second Address | Anderson, SC 29621-1108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2017 |
Last Update Date | 02/07/2019 |