Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | ||
N | 224P00000X | Prosthetist |
NPI | 1699342154 |
---|---|
Provider Name | Emma Nadolski |
First Address | Burlington, NC 27215 |
Second Address | Burlington, NC 27215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7704513 | (05) | NC |