Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | BW1823221 | NC |
N | 111NI0900X | Internist | BW1823221 | NC |
Y | 207RA0401X | Internist - Addiction Medicine | BW1823221 | NC |
NPI | 1093778011 |
---|---|
Provider Name | Dr. Diane White |
First Address | Lumberton, NC 28358-2981 |
Second Address | Whiteville, NC 28472-2835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093778011 | (05) | NC |