Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 219982 | NC |
NPI | 1023503265 |
---|---|
Provider Name | Cecilia Kaechele |
First Address | Davidson, NC 28036-2530 |
Second Address | Statesville, NC 28677 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 10/07/2018 |