| NPI | 1558835355 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN ARTIOLI Credentialing Specialist 843-234-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| 363LF0000X Nurse Practitioner Family | |
| 363LP0200X Nurse Practitioner Pediatrics | |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2021-07-13 |