Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 5034 | NC |
NPI | 1629650940 |
---|---|
Provider Name | Aimee Tolbert |
First Address | Winston Salem, NC 27104-2603 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2021 |
Last Update Date | 26/04/2021 |