| NPI | 1972805190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN D. B. TEMPLE Executive Director 843-629-0236 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: SC 5008) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: SC APN 171) |
| 251S00000X (Licence: SC 5497) | |
| Enumeration Date | 2010-11-19 |
| Last Update Date | 2013-05-17 |