Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 2010-01420 | NC |
N | 207QA0505X | Family Doctor - Adult Medicine | 139328 | NC |
NPI | 1215109509 |
---|---|
Provider Name | Ayesha S Nasir |
First Address | Cary, NC 27519-9105 |
Second Address | Raleigh, NC 27613-1273 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 11/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AC3193226-5008 | DEA (01) | NC |