| NPI | 1376055038 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDY VAN HEYDE Owner 843-750-0324 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2024-09-23 |