Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 25872 | SC |
Y | 2080P0208X | Pediatric Infectious Diseases | 25872 | SC |
NPI | 1649223025 |
---|---|
Provider Name | Sue Joan Jue |
First Address | Greenville, SC 29615-4536 |
Second Address | Greenville, SC 29615-3593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 12/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APPROVED | (05) | SC |