Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C106913 | NC |
NPI | 1326560137 |
---|---|
Provider Name | Annazette Riley |
First Address | New Bern, NC 28562-4156 |
Second Address | New Bern, NC 28562-7840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 01/05/2018 |