Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 25119 | SC |
NPI | 1225626708 |
---|---|
Provider Name | Stephanie Nicole Driggers |
First Address | North Charleston, SC 29406-9196 |
Second Address | North Charleston, SC 29406-9196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2021 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25119 | APRN LICENSE (01) | SC |