Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 200400873 | NC |
NPI | 1225125669 |
---|---|
Provider Name | Janet E Harris-Hicks |
First Address | Hamlet, NC 28345-4567 |
Second Address | Hamlet, NC 28345-4567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 19/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1377E | BCBS ID NUMBER (01) | NC |
891377E | (05) | NC |
I21672 | (02) | NC |
N0087E | (05) | SC |