Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 9300258 | NC |
N | 207RG0300X | Geriatric Medicine | A48135 | CA |
N | 207RG0300X | Geriatric Medicine | MD8274 | HI |
N | 207RH0002X | Hospice and Palliative Medicine | 9300258 | NC |
NPI | 1225097280 |
---|---|
Provider Name | Dr. Kris Nordberg |
First Address | Winston Salem, NC 27130-0543 |
Second Address | Kernersville, NC 27284-7159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2006 |
Last Update Date | 13/09/2018 |