Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | NC |
NPI | 1124683271 |
---|---|
Provider Name | Emily Cavallo |
First Address | Wilmington, NC 28411-6136 |
Second Address | Wilmington, NC 28411-6136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2019 |
Last Update Date | 03/05/2019 |