Provider Demographics
NPI:1346099520
Name:LAROQUE-GOTBETER, ELIZABETH ALBRITTAN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ALBRITTAN
Last Name:LAROQUE-GOTBETER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 RIVERS AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8057
Mailing Address - Country:US
Mailing Address - Phone:843-478-0468
Mailing Address - Fax:
Practice Address - Street 1:37 MARKFIELD DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6965
Practice Address - Country:US
Practice Address - Phone:843-478-0468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC248874163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health