Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1144866369 |
---|---|
Provider Name | Alexandra Wijnhoud |
First Address | Wilmington, NC 28403-1367 |
Second Address | Hampstead, NC 28443-3696 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2019 |
Last Update Date | 22/11/2019 |