Doctor Name: | LINDA EVONNE BROGDON |
NPI Number: | 1013208032 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 1590 Freedom Blvd Ste B Florence, SC - 295056071 |
Business Phone Number: | 8436659581 |
Business Fax Number: | 8436696426 |
Mailing Address: | 1590 Freedom Blvd Ste B, FLORENCE |
State: | SC |
Postal Code: | 295056071 |
Phone Number: | 8436659581 |
Fax Number: | 8436696426 |
NPI Enumeration Date: | 04/25/2011 |
NPI Last Update Date: | 08/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |