Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 9600667 | NC |
Y | 208600000X | Surgeon | 9600667 | NC |
NPI | 1013985860 |
---|---|
Provider Name | Dr. Susan Janis Pabst |
First Address | Hickory, NC 28602-1384 |
Second Address | Hickory, NC 28602-1384 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 31/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2225924B | MEDICARE INDIVIDUAL PTAN (01) | NC |
8964751 | (05) | NC |
G29222 | (02) | NC |