Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5000501 | NC |
NPI | 1033283643 |
---|---|
Provider Name | Ana Maria Fernandez |
First Address | Durham, NC 27710 |
Second Address | Durham, NC 27710-2319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 27/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86361543135001 | (05) | IL |