Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 18468 | SC |
NPI | 1003243056 |
---|---|
Provider Name | Ruth Anne Etter |
First Address | Seneca, SC 29678-0926 |
Second Address | Seneca, SC 29678-0926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2013 |
Last Update Date | 16/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP2784 | (05) | SC |
SC2276I818 | MEDICARE (01) | SC |