Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NC |
NPI | 1124787916 |
---|---|
Provider Name | Amber M Self |
First Address | Fuquay Varina, NC 27526-8465 |
Second Address | Cary, NC 27518-6131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2021 |
Last Update Date | 09/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NA | CASH ONLY (01) | NC |