NPI | 1962183657 |
---|---|
Entity Type | Organization |
Authorized Contact | CORTNEY SHANTRES ELLIS Authorized Official 864-356-4598 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
Enumeration Date | 2023-07-26 |
Last Update Date | 2023-07-26 |