| NPI | 1932862489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAQUITA S WHITE Nurse Practitioner 843-616-7191 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family |
| Additional Taxonomies | 208D00000X General Practice |
| 251E00000X Home Health | |
| 253Z00000X In Home Supportive Care | |
| 261Q00000X Clinic/Center | |
| 261QC1500X Clinic/Center Community Health | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QR1300X Clinic/Center Rural Health | |
| 302R00000X Health Maintenance Organization | |
| 363L00000X Nurse Practitioner | |
| 363LC1500X Nurse Practitioner Community Health | |
| 385H00000X Respite Care | |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2023-02-03 |