| NPI | 1558178996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SELINA FAYE WHITE Owner/Nurse Practitioner 843-992-2682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Enumeration Date | 2024-12-17 |
| Last Update Date | 2024-12-17 |