Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 750 | NC |
N | 213ES0103X | Foot & Ankle Surgery | 750 | NC |
N | 213ES0131X | Foot Surgery | 750 | NC |
NPI | 1477527562 |
---|---|
Provider Name | Dr. Susie Nely Sant Anna |
First Address | Concord, NC 28025-2911 |
Second Address | Wilmington, NC 28403-6840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2006 |
Last Update Date | 24/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U50906 | (02) | TX |