Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 122192 | NC |
Y | 111NI0900X | Internist | 122192 | NC |
N | 207SG0201X | Clinical Genetics (M.D.) | 122192 | NC |
NPI | 1861667065 |
---|---|
Provider Name | Dr. Michele Spencer-Manzon |
First Address | Durham, NC 27704-0001 |
Second Address | Durham, NC 27704-2702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2008 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5909828 | (05) | NC |