Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C19732 | NC |
NPI | 1851355986 |
---|---|
Provider Name | Dorothy V Bullins |
First Address | Salisbury, NC 28146-8424 |
Second Address | Salisbury, NC 28146-8424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 07/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0438V | BCBS (01) | NC |
7703005 | (05) | NC |