Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 200201393 | NC |
NPI | 1750308664 |
---|---|
Provider Name | Emidio Michael Novembre |
First Address | Elkin, NC 28621-2237 |
Second Address | Elkin, NC 28621-2237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 14/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010126401 | (05) | VA |
89132UV | (05) | NC |
F82262 | (02) | NC |