Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 19625 | SC |
NPI | 1023484946 |
---|---|
Provider Name | Sandra Streisel Jones |
First Address | Charlotte, NC 28275-1649 |
Second Address | Charleston, SC 29401-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2015 |
Last Update Date | 26/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP3560 | (05) | SC |
SC73585551 | MEDICARE PIN (01) | SC |