Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 2017-01136 | NC |
N | 207VG0400X | Gynecologist | 2017-01136 | NC |
N | 207VX0000X | Obstetrician | 2017-01136 | NC |
NPI | 1295122109 |
---|---|
Provider Name | Alisa Katherine Eanes |
First Address | Marion, NC 28752-5239 |
Second Address | Marion, NC 28752-5239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2015 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2017-01136 | MEDICAL LICENSE (01) | NC |
NN735A | MAHEC MEDICARE PTAN (01) | NC |