Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 4387 | NC |
NPI | 1134216997 |
---|---|
Provider Name | Dr. Jane Elizabeth Parker |
First Address | Matthews, NC 28105 |
Second Address | Matthews, NC 28105 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U52770 | (02) |