Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1477675676 |
---|---|
Provider Name | Anna Boyd Jefferson |
First Address | Burlington, NC 27215-5934 |
Second Address | Burlington, NC 27215-5934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0494I | BLUE CROSS BLUE SHIELD (01) | NC |
7704513 | (05) | NC |