Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 2016-00348 | NC |
NPI | 1003158452 |
---|---|
Provider Name | Anna Mooney |
First Address | Clyde, NC 28721-6620 |
Second Address | Clyde, NC 28721-6620 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2013 |
Last Update Date | 04/05/2016 |