Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 1102 | MN |
NPI | 1023778289 |
---|---|
Provider Name | Dr. Kelly Ann Tomko |
First Address | Durham, NC 27705-5571 |
Second Address | Durham, NC 27705-5571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2021 |
Last Update Date | 28/12/2021 |