Individual
GWENDOLYN ELAINE PETERSON-TAITAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1535 PLATT SPRINGS RD # 4283, WEST COLUMBIA, SC 29169-5502
(760) 223-3098
Mailing address
1535 PLATT SPRINGS RD # 4283, WEST COLUMBIA, SC 29169-5502
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
24676
SC
Other
Enumeration date
06/03/2021
Last updated
01/17/2024
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