Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 4310 | SC |
NPI | 1043510795 |
---|---|
Provider Name | Shannon W Easterlin |
First Address | Orangeburg, SC 29115-4930 |
Second Address | Orangeburg, SC 29115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2010 |
Last Update Date | 09/03/2020 |