Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 2017-01530 | NC |
Y | 207KA0200X | Allergist | 2017-01530 | NC |
N | 207RA0201X | Internist - Allergy & Immunology | 2017-01530 | NC |
NPI | 1659714319 |
---|---|
Provider Name | Jamie Waldron |
First Address | Durham, NC 27713-8359 |
Second Address | Chapel Hill, NC 27599-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2013 |
Last Update Date | 07/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1659714319 | (05) | AR |