Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 39940 | NC |
NPI | 1003866211 |
---|---|
Provider Name | Dr. Christina Marie Flannelly |
First Address | Raleigh, NC 27607-4189 |
Second Address | Raleigh, NC 27615-4731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8932454 | (05) | NC |