Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2009-00855 | NC |
N | 208000000X | Pediatrician | 2009-00855 | NC |
NPI | 1043490113 |
---|---|
Provider Name | Jennifer Laiacona Caicedo |
First Address | Charlotte, NC 28277-8915 |
Second Address | Charlotte, NC 28277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2007 |
Last Update Date | 28/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10434901113 | (05) | NC |
AA53535215 | (05) | SC |