Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 200001098 | NC |
NPI | 1124002423 |
---|---|
Provider Name | Angela Paige Bennett |
First Address | Winston Salem, NC 27102-0344 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 08/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10005299 | (05) | VA |
1339U | BCBS (01) | NC |
1841917000 | (05) | WV |
7606737 | AETNA (01) | NC |
802876 | PARTNERS (01) | NC |
891339U | (05) | NC |
C6266 | MEDCOST (01) | NC |
H85714 | (02) | |
Q98000 | (05) | SC |