Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 800039 | NC |
NPI | 1457337693 |
---|---|
Provider Name | Elizabeth Lane |
First Address | Greensboro, NC 27408-7007 |
Second Address | Greensboro, NC 27408-7007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
S91211 | (02) | NC |