Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 9092 | NC |
NPI | 1073727178 |
---|---|
Provider Name | Ivelis Hernandez-Ramirez |
First Address | Durham, NC 27707-3771 |
Second Address | Durham, NC 27707-3771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 22/02/2019 |