Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9601595 | NC |
NPI | 1003005679 |
---|---|
Provider Name | Dr. Yvette Renee Douglas-Lewis |
First Address | Warrenton, NC 27589-8723 |
Second Address | Warrenton, NC 27589-8723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2007 |
Last Update Date | 29/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7910404 | (05) | NC |
G56065 | (02) | NC |