Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | 200000409 | NC |
N | 207NS0135X | Procedural Dermatology | 200000409 | NC |
NPI | 1134123847 |
---|---|
Provider Name | Audrey F Echt |
First Address | Raleigh, NC 27614-6499 |
Second Address | Raleigh, NC 27614-6499 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89127F7 | MEDICAID (01) | NC |
G27857 | (02) |