Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RI0200X | Infectious Disease | 2012-00503 | NC |
Y | 207RI0200X | Infectious Disease | UNDER YNHH | CT |
NPI | 1023342938 |
---|---|
Provider Name | Dr. Nisha Thannikkary Manickam |
First Address | Raleigh, NC 27607-2973 |
Second Address | Raleigh, NC 27607-2973 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2009 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5921923 | (05) | NC |