Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 19467 | SC |
NPI | 1003295262 |
---|---|
Provider Name | Victoria Fenters |
First Address | Atlanta, GA 30374-3904 |
Second Address | Lexington, SC 29072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 09/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP4913 | (05) | SC |