Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C51774 | NC |
NPI | 1437712601 |
---|---|
Provider Name | Anitra Nash Phifer |
First Address | Gastonia, NC 28052-5437 |
Second Address | Gastonia, NC 28054-1421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 15/04/2019 |